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Osteoporosis, Glucocorticoid-Related Osteoporosis and Glucocorticoid Withdrawal Regimen

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Rheumatic Disease in Geriatrics

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Abstract

Osteoporosis in rheumatic diseases is a very well-known complication. The possible combination of age-related bone loss, sarcopenia, potential frailty, reduced physical activity, joint deformities and increased risk of falls, systemic inflammatory disease, and glucocorticoid treatment, places elderly patients with rheumatic diseases at extremely high risk for osteoporotic fracture. All elderly patients with rheumatic diseases, regardless of other fracture risks, should be considered for non-pharmacological interventions. Elderly patients with previous fragility fracture, patients with osteoporosis, and patients with ongoing treatment with supra-physiological corticosteroid dosage should be candidates for pharmacological treatment. Elderly patients with osteopenia should be evaluated for clinical fracture risk in order to decide whether they should be treated pharmacologically. Bisphosphonates are often the first-line pharmacological treatment choice for osteoporosis in most countries, and the duration of treatment is an issue that should be considered carefully. Long-standing glucocorticoid treatment may lead to hypothalamic-pituitary-adrenal suppression, making patients steroid-dependent, and glucocorticoid cessation in these patients may lead to adrenal insufficiency. Here we propose a practical and simplified regimen for steroid withdrawal.

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Authors and Affiliations

  1. Bnai Zion Medical Center, Institute of Endocrinology, Haifa, Israel

    Leonard Saiegh & Mohammad Sheikh-Ahmad

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  1. Leonard Saiegh
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  2. Mohammad Sheikh-Ahmad
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Correspondence to Leonard Saiegh .

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Editors and Affiliations

  1. Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel

    Gleb Slobodin

  2. Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel

    Yehuda Shoenfeld

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Saiegh, L., Sheikh-Ahmad, M. (2020). Osteoporosis, Glucocorticoid-Related Osteoporosis and Glucocorticoid Withdrawal Regimen. In: Slobodin, G., Shoenfeld, Y. (eds) Rheumatic Disease in Geriatrics . Springer, Cham. https://doi.org/10.1007/978-3-030-44234-7_8

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  • DOI: https://doi.org/10.1007/978-3-030-44234-7_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-44233-0

  • Online ISBN: 978-3-030-44234-7

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