Suggested rationale for prevention and treatment of glucocorticoid-induced bone loss in dermatologic patients.
Glucocorticoid-induced bone loss is the most predictable and debilitating complication of prolonged administration of systemic corticosteroids. It has been shown that patients treated with glucocorticoids have an increased risk of osteoporotic fractures, resulting in marked morbidity, particularly in elderly individuals. Studies on the effect of glucocorticoids on bone density and the efficacy of treatment regimens (namely, bisphosphonates and calcitonin) for preventing bone loss have been mainly on patients with asthma and rheumatologic diseases. However, no long-term studies have been done on the impact of prolonged corticosteroid treatment in dermatologic patients. The purpose of this review is to raise awareness about osteoporosis and new preventive measures among the dermatologists treating patients with glucocorticoids at high doses and for long periods. We summarize the assessment methods used to evaluate this condition, examine the results of clinical trials of drugs, and suggest a practical approach to managing corticosteroid osteoporosis in dermatologic patients based on data collected from published articles.
Yosipovitch
G
G
National Skin Center, 1 Mandalay Rd, Singapore 308205. gil@nsc.gov.sg
Hoon
T S
TS
Leok
G C
GC
D000328:Adult; D000367:Age Factors; D000368:Aged; D002116:Calcitonin / Q000627:therapeutic use; D002118:Calcium / Q000627:therapeutic use; D018849:Controlled Clinical Trials as Topic; D003720:Densitometry; D004164:Diphosphonates / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy; D004966:Estrogens, Conjugated (USP) / Q000008:administration & dosage; D015444:Exercise; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced* / Q000188:drug therapy / Q000517:prevention & control; D015663:Osteoporosis, Postmenopausal / Q000517:prevention & control; D020849:Raloxifene Hydrochloride / Q000627:therapeutic use; D012307:Risk Factors; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use; D012871:Skin Diseases / Q000188:drug therapy*; D013997:Time Factors; D014807:Vitamin D / Q000627:therapeutic use
D004164:Diphosphonates; D004966:Estrogens, Conjugated (USP); D005938:Glucocorticoids; D020845:Selective Estrogen Receptor Modulators; D014807:Vitamin D; D020849:Raloxifene Hydrochloride; D002116:Calcitonin; D002118:Calcium