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Glucocorticoid-induced osteoporosis: Treatment options and guidelines

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Abstract

Glucocorticoid-induced osteoporosis and fractures are the most frequent adverse effects of this class of medication. Recent advances in the pathophysiology, epidemiology, detection, and prevention of this complication of therapy provide hope for its amelioration in patients who require treatment with glucocorticoids. A number of effective pharmacologic agents are available and/or under study, and scientific organizations now provide guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis. Unfortunately, consistent application of these guidelines remains suboptimal in many practice settings.

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References and Recommended Reading

  1. Cushing H: The basophil adenomas of the pituitary body and their clinical manifestations (pituitary basophilism). Bull Johns Hopkins Hosp 1932, 50:137–195.

    Google Scholar 

  2. Curtis PH, Clark WS, Herndon CH: Vertebral fractures resulting from prolonged cortisone and corticotropin therapy. JAMA 1954, 156:467–469.

    Google Scholar 

  3. Saag KG, Koehnke R, Caldwell JR, et al.: Low dose long-term corticosteroid therapy in rheumatoid arthritis: an analysis of serious adverse events. Am J Med 1994, 96:115–123.

    Article  PubMed  CAS  Google Scholar 

  4. Hofbauer LC, Gori F, Riggs BL, et al.: Stimulation of osteoprotegerin ligand and inhibition of osteoprotegerin production by glucocorticoids in human osteoblastic lineage cells: potential paracrine mechanisms of glucocorticoid-induced osteoporosis. Endocrinology 1999, 140:4382–4389.

    Article  PubMed  CAS  Google Scholar 

  5. Weinstein RS, Jilka RL, Parfitt AM, et al.: Inhibition of osteoblastogenesis and promotion of apoptosis of osteoblasts and osteocytes by glucocorticoids: potential mechanisms of their deleterious effects on bone. J Clin Invest 1998, 102:274–282.

    PubMed  CAS  Google Scholar 

  6. Weinstein RS, Jilka RL, Parfitt M, et al.: Inhibition of osteoblastogenesis and promotion of apoptosis of osteoblasts and osteocytes by glucocorticoids: potential mechanisms of their deleterious effects on bone. J Clin Invest 1998, 102:274–282.

    PubMed  CAS  Google Scholar 

  7. Weinstein RS, Powers CC, Parfitt AM, et al.: Preservation of osteocyte viability by bisphosphonates contributes to bone strength in glucocorticoid-treated mice independently of BMD: an unappreciated determinant of bone strength. J Bone Miner Res 2002, 17(Suppl 1):S156.

    Google Scholar 

  8. Laan RF, van Riel PL, van de Putte LB, et al.: Low-dose prednisone induces rapid reversible axial bone loss in patients with rheumatoid arthritis. Ann Intern Med 1993, 119:963–968.

    PubMed  CAS  Google Scholar 

  9. van Staa T, Leufkens H, Abenhaim L, et al.: Use of oral corticosteroids and risk of fractures. J Bone Miner Res 2000, 15:993–1000. Landmark article describing increased fracture risk in patients on even low-dose glucocorticoids.

    Article  PubMed  Google Scholar 

  10. van Staa TP, Leufkens HMG, Abenhaim L, et al.: Oral corticosteroids and fracture risk: relationship to daily and cumulative doses. Rheumatology 2000, 39:1383–1389.

    Article  PubMed  Google Scholar 

  11. van Staa TP, Leufkens HGM, Cooper C: Use of inhaled corticosteroids and risk of fractures. J Bone Miner Res 2001, 3:581–588.

    Article  Google Scholar 

  12. World Health Organization: Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Technical report series 843; 1994, Geneva:WHO.

    Google Scholar 

  13. van Staa TP, Laan RF, Barton IP, et al.: Bone density threshold and other predictors of vertebral fracture in patients receiving oral glucocorticoid therapy. Arthritis Rheum 2003, 48:3224–3229.

    Article  PubMed  CAS  Google Scholar 

  14. Cohen S, Levy RM, Keller M, et al.: Risedronate therapy prevents cortico steroid-induced bone loss: a twelve-month, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Arthritis Rheum 1999, 42:2309–2318.

    Article  PubMed  CAS  Google Scholar 

  15. Reid DM, Hughes R, Laan RF: Efficacy and safety of daily risedronate in the treatment of corticosteroid-induced osteoporosis in men and women: a randomized trial. J Bone Miner Res 2000, 15:1006–1013.

    Article  PubMed  CAS  Google Scholar 

  16. American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis: Recommendation for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheum 2001, 44:1496–1503.

    Article  Google Scholar 

  17. Royal College of Physicians, National Osteoporosis Society, Bone and Tooth Society of Great Britain: Glucocorticoid-induced osteoporosis—guidelines for prevention and treatment. London, Royal College of Physicians, 2002.

    Google Scholar 

  18. Amin S, LaValley MP, Simms RW, et al.: The role of vitamin D in corticosteroid-induced osteoporosis: a meta-analytic approach. Arthritis Rheum 1999, 42:1740–1751.

    Article  PubMed  CAS  Google Scholar 

  19. de Nijs RNJ, Jacobs JWG, Algra A, et al.: Prevention and treatment of glucocorticoid-induced osteoporosis with active vitamin D3 analogues: a review with meta-analysis of randomized controlled trials including organ transplantation studies. Osteoporos Int 2004, 15:589–602.

    Article  PubMed  CAS  Google Scholar 

  20. Saag KG, Emkey R, Schnitzer T, et al.: Alendronate for the treatment and prevention glucocorticoid-induced osteoporosis. N Engl J Med 1998, 339:292–299.

    Article  PubMed  CAS  Google Scholar 

  21. Adachi JD, Saag K, Emkey R, et al.: Effects of alendronate for two years on BMD and fractures in patients receiving glucocorticoids. Arthritis Rheum 2001, 44:202–211.

    Article  PubMed  CAS  Google Scholar 

  22. Wallach S, Cohen S, Reid DM, et al.: Effects of risedronate treatment on bone density and vertebral fracture in patients on cortico steroid therapy. Calcif Tissue Int 2000, 67:277–285.

    Article  PubMed  CAS  Google Scholar 

  23. Adachi JD, Bensen WG, Brown J, et al.: Intermittent etidronate therapy to prevent corticosteroid induced osteoporosis. N Engl J Med 1997, 337:382–387.

    Article  PubMed  CAS  Google Scholar 

  24. Amin S, LaValley MP, Simms RW, et al.: The comparative efficacy of drug therapies used for the management of cortico steroid-induced osteoporosis: a meta-regression. ] Bone Miner Res 2002, 17:1512–1526. Comprehensive review of the efficacy of therapeutic options in GIOP.

    Article  CAS  Google Scholar 

  25. Boutsen Y, Jamart J, Esselinckx W, et al.: Primary prevention of glucocorticoid-induced osteoporosis with intravenous pamidronate and calcium: a prospective controlled 1-year study comparing a single infusion, an infusion given once every 3 months, and calcium alone. J Bone Miner Res 2001, 16:104–112.

    Article  PubMed  CAS  Google Scholar 

  26. Reid IR, Brown JP, Burckhardt P, et al.: Intravenous zoledronic acid in postmenopausal women with low bone mineral density. N Engl J Med 2002, 346:653–661.

    Article  PubMed  CAS  Google Scholar 

  27. Ringe JD, Dorst A, Faber H, et al.: Intermittent intravenous ibandronate injections reduce vertebral fracture risk in cortico steroid-induced osteoporosis: results from a longterm comparative study. Osteoporos Int 2003, 14:801–807. Well done study suggesting that intermittent intravenous bisphosphonates may have a role in the treatment of GIOP.

    Article  PubMed  CAS  Google Scholar 

  28. Lane NE, Sanchez S, Modin GW, et al.: Parathyroid hormone treatment can reverse corticosteroid-induced osteoporosis. Results of a randomized controlled clinical trial. J Clin Invest 1998, 102:1627–1633.

    Article  PubMed  CAS  Google Scholar 

  29. Lane NE, Sanchez S, Modin GW, et al.: Bone mass continues to increase at the hip after parathyroid hormone treatment is discontinued in glucocorticoid induced osteoporosis: results of a randomized controlled clinical trial. J Bone Miner Res 2000, 15:944–951.

    Article  PubMed  CAS  Google Scholar 

  30. Healey JH, Paget SA, Williams-Russo P, et al.: A randomized controlled trial of salmon calcitonin to prevent bone loss in cortico steroid-treated temporal arteritis and polymyalgia rheumatica. Calcif Tissue Int 1996, 58:73–80.

    PubMed  CAS  Google Scholar 

  31. Hall GM, Daniels M, Doyle DV, et al.: Effect of hormone replacement therapy on bone mass in rheumatoid arthritis patients treated with and without steroids. Arthritis Rheum 1994, 37:1499–1505.

    Article  PubMed  CAS  Google Scholar 

  32. Reid IR, Wattie DJ, Evans MC, et al.: Testosterone therapy in glucocorticoid-treated men. Arch Intern Med 1996, 156:1173–1177.

    Article  PubMed  CAS  Google Scholar 

  33. Rossouw JW, Anderson GL, Prentice RL, et al.: Risks and benefits of estrogen plus progestin in healthy post-menopausal women: principal results from the women’s health initiative randomized controlled trial. JAMA 2002, 288:321–333.

    Article  PubMed  CAS  Google Scholar 

  34. Rhoden EL, Morgentaler A: Risks of testosterone-replacement therapy and recommendations for monitoring. N Engl J Med 2004, 350:482–492.

    Article  PubMed  CAS  Google Scholar 

  35. Solomon DH, Katz JN, Jacobs JP, et al.: Management of glucocorticoid-induced osteoporosis in patients with rheumatoid arthritis. Arthritis Rheum 2002, 46:3136–3142.

    Article  PubMed  Google Scholar 

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Maricic, M. Glucocorticoid-induced osteoporosis: Treatment options and guidelines. Curr Osteoporos Rep 3, 25–29 (2005). https://doi.org/10.1007/s11914-005-0024-8

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