Corticosteroid-induced osteoporosis: a guide to optimum management.
Corticosteroid-induced osteoporosis is the leading cause of secondary osteoporosis and a significant cause of morbidity in both men and women. Long-term use of even low-dose corticosteroids has been associated with increased risk of bone loss. Recent large randomized controlled trials have generated new knowledge on treatment strategies for patients with corticosteroid-induced osteoporosis. However, the majority of individuals receiving corticosteroids are not receiving prophylaxis for osteoporosis. Calcium and vitamin D should be recommended to patients initiating therapy with corticosteroids (and should be adequate for those receiving corticosteroids for less than 3 months). For those receiving corticosteroids for greater than 3 months, bisphosphonates are the therapy of choice, with both alendronate (alendronic acid) and risedronate (risedronic acid) approved by the US FDA for use in this indication. Calcitonin can be considered a second-line agent and should be reserved for patients who are intolerant of bisphosphonates or who are experiencing pain from a vertebral fracture. Hormone replacement therapy or testosterone therapy may be offered to those individuals on long-term corticosteroid treatment who are hypogonadal. Teriparatide (recombinant human parathyroid hormone 1-34) shows promise as a future anabolic agent for the prevention and treatment of patients with corticosteroid-induced osteoporosis.
Cranney
Ann
A
Queen's University, Kingston, Ontario, Canada.
Adachi
Jonathan D
JD
D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D002118:Calcium / Q000627:therapeutic use*; D004164:Diphosphonates / Q000627:therapeutic use; D006801:Humans; D010024:Osteoporosis / Q000139:chemically induced* / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D014807:Vitamin D / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D004164:Diphosphonates; D014807:Vitamin D; D002118:Calcium