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Journal of Osteoporosis
Volume 2015 (2015), Article ID 729451, 7 pages
http://dx.doi.org/10.1155/2015/729451
Research Article

Oral Calcidiol Is More Effective Than Cholecalciferol Supplementation to Reach Adequate 25(OH)D Levels in Patients with Autoimmune Diseases Chronically Treated with Low Doses of Glucocorticoids: A “Real-Life” Study

1Unidad de Medicina Familiar y Comunitaria, Hospital Son Llàtzer, Palma de Mallorca, Spain
2Unidad de Enfermedades Autoinmunes, Hospital Clínico San Cecilio, Granada, Spain
3Servicio de Medicina Interna, Hospital Son Llàtzer, Palma de Mallorca, Spain
4Biomedical Research Institute, ibs. GRANADA, University Hospitals in Granada, University of Granada, Spain
5Servicio de Reumatología, Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain

Received 4 March 2015; Revised 15 May 2015; Accepted 19 May 2015

Academic Editor: Jun Iwamoto

Copyright © 2015 Miguel Ortego-Jurado et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Glucocorticoids (GCs) are the cornerstone of the therapy in many autoimmune and inflammatory diseases. However, it is well known that their use is a double edged sword, as their beneficial effects are associated almost universally with unwanted effects, as, for example glucocorticoid-induced osteoporosis (GIO). Over the last years, several clinical practice guidelines emphasize the need of preventing bone mass loss and reduce the incidence of fractures associated with GC use. Calcium and vitamin D supplementation, as adjunctive therapy, are included in all the practice guidelines. However, no standard vitamin D dose has been established. Several studies with postmenopausal women show that maintaining the levels above 30–33 ng/mL help improve the response to bisphosphonates. It is unknown if the response is the same in GIO, but in the clinical practice the levels are maintained at around the same values. In this study we demonstrate that patients with autoimmune diseases, undergoing glucocorticoid therapy, often present suboptimal 25(OH)D levels. Patients with higher body mass index and those receiving higher doses of glucocorticoids are at increased risk of having lower levels of 25(OH)D. In these patients, calcidiol supplementations are more effective than cholecalciferol to reach adequate 25(OH)D levels.