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Treatment and Prevention of Glucocorticoid-Induced Osteoporosis

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Blistering Diseases

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Abstract

Glucocorticoids increase bone resorption and inhibit bone formation, increasing the risk of osteoporosis and fragility fracture. Early, rapid decline in bone mineral density occurs within the first 3–6 months of glucocorticoid therapy, even at low doses. Therefore, risk assessment, counseling, and preventative measures should be implemented early, at the outset of therapy. Such strategies include the use of the lowest effective glucocorticoid dose; certain lifestyle modifications, such as weight-bearing exercise and fall prevention; and calcium and vitamin D supplementation in all patients. A dual-energy x-ray absorptiometry (DXA) scan should be performed to evaluate bone mineral density. Those with osteoporosis (T-score < −2.5) and osteopenia (T-score between −2.5 and −1.0) are at increased risk of fragility fracture and may be candidates for pharmacologic therapy depending on individual factors such as age, sex, and Fracture Risk Assessment Tool (FRAX) risk calculation. Options for therapy include bisphosphonates, which have demonstrated safety and efficacy and are first-line agents for fracture prevention. Close monitoring of bone mineral density with annual DXA scan of the lumbar spine and hip is warranted while taking glucocorticoids to evaluate for bone demineralization and response to therapy.

Grant support: Merit Review Grant from the CDC, Department of Veterans Affairs Veterans Health Administration, Office of Research and Development, Biomedical Laboratory Research and Development, and the National Institutes of Health (NIH K24-AR 02207) to Dr. Victoria P. Werth.

Financial Disclosure: No disclosure relevant to the manuscript.

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Authors and Affiliations

  1. Department of Dermatology and Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Robert G. Micheletti MD

  2. Department of Dermatology, St George Hospital, University of NSW Medical School, Sydney, NSW, Australia

    Dédée F. Murrell MA(Camb), BMBCh(Oxf), FAAD, MD, FACD, FRCP

  3. Department of Dermatology and Medicine, Philadelphia VAMC and University of Pennsylvania, Philadelphia, PA, USA

    Victoria P. Werth MD

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  1. Robert G. Micheletti MD
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  2. Dédée F. Murrell MA(Camb), BMBCh(Oxf), FAAD, MD, FACD, FRCP
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  3. Victoria P. Werth MD
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Correspondence to Victoria P. Werth MD .

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Editors and Affiliations

  1. Department of Dermatology, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia

    Dédée F. Murrell

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Micheletti, R.G., Murrell, D.F., Werth, V.P. (2015). Treatment and Prevention of Glucocorticoid-Induced Osteoporosis. In: Murrell, D. (eds) Blistering Diseases. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45698-9_63

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