Management of corticosteroid-induced osteoporosis.
OBJECTIVE
To educate scientists and health care providers about the effects of corticosteroids on bone, and advise clinicians of the appropriate treatments for patients receiving corticosteroids.


METHODS
This review summarizes the pathophysiology of corticosteroid-induced osteoporosis, describes the assessment methods used to evaluate this condition, examines the results of clinical trials of drugs, and explores a practical approach to the management of corticosteroid-induced osteoporosis based on data collected from published articles.


RESULTS
Despite our lack of understanding about the biological mechanisms leading to corticosteroid-induced bone loss, effective therapy has been developed. Bisphosphonate therapy is beneficial in both the prevention and treatment of corticosteroid-induced osteoporosis. The data for the bisphosphonates are more compelling than for any other agent. For patients who have been treated but continue to lose bone, hormone replacement therapy, calcitonin, fluoride, or anabolic hormones should be considered. Calcium should be used only as an adjunctive therapy in the treatment or prevention of corticosteroid-induced bone loss and should be administered in combination with other agents.


CONCLUSIONS
Bisphosphonates have shown significant treatment benefit and are the agents of choice for both the treatment and prevention of corticosteroid-induced osteoporosis.
Adachi
J D
JD
Department of Medicine, St Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada.
Olszynski
W P
WP
Hanley
D A
DA
Hodsman
A B
AB
Kendler
D L
DL
Siminoski
K G
KG
Brown
J
J
Cowden
E A
EA
Goltzman
D
D
Ioannidis
G
G
Josse
R G
RG
Ste-Marie
L G
LG
Tenenhouse
A M
AM
Davison
K S
KS
Blocka
K L
KL
Pollock
A P
AP
Sibley
J
J
D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D000465:Algorithms; D015519:Bone Density; D001862:Bone Resorption; D004164:Diphosphonates / Q000627:therapeutic use; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000139:chemically induced* / Q000517:prevention & control; D015663:Osteoporosis, Postmenopausal / Q000517:prevention & control; D018570:Risk Assessment
D000305:Adrenal Cortex Hormones; D004164:Diphosphonates