It is very well known that the use of glucocorticoids can provoke a dose dependent bone loss, and therefore an increased risk of fracture. It is also very well known that currently glucocorticoids continue to be the mainstay of therapy when managing immunobullous skin diseases. Moreover, immunobullous skin diseases are frequently treated with high doses and long-term courses of glucocorticoids. Currently, bisphosphonates are considered as the first-line therapy in the prophylaxis of glucocorticoid-induced osteoporosis.
In a very interesting paper just published in the Archives of Dermatology, Dr. Shang-Ian Tee and collaborators present a placebo-controlled, 12-month randomized, double-blind trial, focusing on the efficacy and safety of alendronate sodium (10 mg) with calcium plus vitamin D vs calcium plus vitamin D alone, administered orally to patients suffering from a newly diagnosed immunobullous disease.
29 patients were enrolled in the study: 15 in the alendronate group and 14 in the placebo group. The authors documented a statistically significant increase in bone mineral density compared with the placebo group at the lumbar spine (P=.01) and the femoral neck (P=.01). Adverse events occurred in both groups and were generally minor: headaches, rashes, dyspepsia and musculoskeletal pain.
Dr. Shang-Ian Tee and co-workers remind us that guidelines usually recommend treatment with bisphosphonates for patients who receive at least 7.5 mg of prednisone per day during 3 months, but they underline that these guidelines are based on patients suffering from non dermatological disorders. According to the authors this is the first controlled randomized study assessing the benefits of early bisphosphonate treatment in patients suffering from immunobullous skin diseases, a therapeutic strategy that they recommend in the everyday clinical practice.