Link between estrogen, steroids seen

July 26, 1995|By Medical Tribune News Service

Sometimes the wheels of progress turn faster than expected.

Last week, scientists reported that low-dose steroids are effective for treating rheumatoid arthritis -- but other experts warned that long-term use of steroids can cause bone loss.

Now, another group of researchers reports that estrogen-replacement therapy can block the bone-damaging effects of steroid treatment.

British and French investigators, led by Dr. G. M. Hall of St. Thomas Hospital in London, studied 106 postmenopausal women with rheumatoid arthritis. Thirty-five of the women were taking low-dose steroids for their arthritis; the rest were not.

All the women were randomly assigned to receive estrogen-replacement therapy or calcium for two years.

By the end of the study, bone density had increased by more than 3 percent in women taking estrogen, regardless of whether they were being treated with steroids.

Among those who took calcium supplements, bone density decreased by 1 percent, the researchers reported in the July issue of the journal Arthritis & Rheumatism.

Estrogen is believed to help protect against bone loss, which can lead to the brittle-bone disease osteoporosis. It often is given to postmenopausal women as protection against fragile bones, because estrogen production drops sharply when menopause occurs.

"It looks like estrogen-replacement therapy will counteract the negative effects of steroids on bone" for people who are taking low doses of steroids, said Dr. Lenore Buckley, an associate professor of medicine and pediatrics at the Medical College of Virginia in Richmond.

"If people who take low-dose steroids are women and are postmenopausal, they should discuss preventive therapies for osteoporosis with their primary-care physician," Dr. Buckley said.

The Virginia researcher is conducting her own study of whether calcium and vitamin D can protect against the bone loss caused by steroids. Preliminary results suggest that the nutrient combination does offer such protection, she said.

Rheumatoid arthritis, which affects more than 2 million Americans, is a chronic disease that causes pain, stiffness, swelling, loss of joint function and inflammation of other organs. It is thought to be an autoimmune disease, in which the body's inflammatory cells turn against the body, and eat away at the cartilage in bone joints.

The disease affects two to three times more women than men, according to the Arthritis Foundation.

Last week, British researchers reported in the New England Journal of Medicine that two years of continuous treatment with the steroid prednisolone stopped rheumatoid arthritis from progressing, and alleviated pain and disability.

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