The long-term treatment of steroid osteoporosis with fluoride

Twenty-two patients with steroid-induced osteoporosis were studied retrospectively to assess the effects on bone mass of fluoride therapy over 4 years. Thirteen of 19 patients with miscellaneous disorders and 2 with Cushing's syndrome received 1 g calcium/day, 50,000 IU vitamin D (D) weekly, and 40–60 mg/day sodium fluoride (F). Six patients with miscellaneous disorders and one with Cushing's syndrome received only Ca and vitamin D. The mean (±SD) cumulative dose of prednisone for fluoride-treated patients at the beginning of the study was 42 ± 25 g, and for those patients treated with only Ca and vitamin D, 45 ± 47 g, and during the study the cumulative dose was comparable in both groups. The bone mineral mass of the central skeleton was measured by neutron activation analysis and the results expressed as the calcium bone index (CaBI) which normalizes the results to that of young adults of the same body size (normal range 0.75–1.2). In the 13 patients with miscellaneous disorders treated with fluoride, the mean ± SD CaBI rose from 0.65 ± .03 to 0.75 ± .03 after 3 years p < 0.001) and to 0.81 ± .11 at 4 years. Patients without fluoride had an initial mean CaBI of 0.70 ± .08 and it was not significantly changed over 3 years, 0.68 ± .09 and 4 years, 0.71 ± .09. The rise in CaBI in fluoride-treated patients with steroid-induced osteoporosis including Cushing's syndrome was comparable to that of 61 patients with postmenopausal osteoporosis treated with fluoride. In steroid osteoporotic patients treated with fluoride, fractures occurred in the first 2 years when the CaBI was still quite low. The results indicate that long-term fluoride therapy significantly increases bone mass in patients with steroid-induced osteoporosis to a similar degree as in patients with postmenopausal osteoporosis.