Glucocorticoid osteoporosis.
Postmenopausal women are at greatest risk of rapid bone loss and fracture with glucocorticoids and should be actively considered for prophylactic measures. In men and premenopausal women receiving glucocorticoids, the decision to use anti-osteoporosis prophylaxis is less clear and depends upon baseline bone mineral density [BMD], anticipated dose and duration of glucocorticoids. Based upon evidence the order of choice for prophylaxis would be a bisphosphonate followed by a vitamin D metabolite or hormone replacement therapy [HRT]. Calcium alone appears unable to prevent rapid bone loss in patients starting glucocorticoids. HRT should clearly be considered if hypogonadism is present. In patients receiving chronic low dose glucocorticoids, treatment with calcium and vitamin D may be sufficient to prevent further bone loss. However since fracture risk is a function of multiple factors including the degree of reduction in BMD as well as the duration of exposure, treatment with therapy to increase BMD will reduce fracture risk even in patients receiving chronic low dose glucocorticoids.
Sambrook
Philip N
PN
Institute of Bone & Joint Research, University of Sydney, Sydney, Australia. mchurchi@doh.health.nsw.gov.au
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015519:Bone Density; D002986:Clinical Trials as Topic; D004305:Dose-Response Relationship, Drug; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D020249:Hormone Replacement Therapy; D006801:Humans; D007006:Hypogonadism / Q000188:drug therapy; D010024:Osteoporosis / Q000139:chemically induced* / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000503:physiopathology; D012216:Rheumatic Diseases / Q000188:drug therapy; D013256:Steroids
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D013256:Steroids