Prevention and treatment of glucocorticoid-induced osteoporosis.
Glucocorticoids continue to be used for many inflammatory diseases, and glucocorticoid-induced osteoporosis (GIOP) remains the most common secondary form of metabolic bone disease. Recent meta-analyses suggest that both active and native vitamin D can help maintain lumbar spine bone mineral density (BMD), particularly in patients receiving lower-dose glucocorticoid therapy. Recent randomized, controlled clinical trials have shown that oral bisphosphonates are superior to vitamin D in maintaining BMD and should be continued for as long as a person receives glucocorticoid treatment. Similar to the oral bisphosphonates, intravenous ibandronate has been shown to preserve BMD and also to significantly reduce vertebral fracture risk. Increasing evidence supports a role for parathyroid hormone to prevent or treat GIOP as well. Despite effective therapies, many at-risk patients fail to receive treatment for GIOP, and even among those who initiate treatment, half discontinue within 1 to 2 years. New approaches to evidence implementation are being tested to improve the quality of osteoporosis care and decrease fracture risk among long-term glucocorticoid users.
Curtis
Jeffrey R
JR
University of Alabama at Birmingham, FOT 840, 510 20th Street South, Birmingham, AL 35294, USA. jcurtis@uab.edu
Saag
Kenneth G
KG
D019386:Alendronate / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002118:Calcium / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004164:Diphosphonates / Q000627:therapeutic use; D012968:Etidronic Acid / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D000077557:Ibandronic Acid; D008297:Male; D010024:Osteoporosis / Q000139:chemically induced / Q000188:drug therapy* / Q000517:prevention & control; D010281:Parathyroid Hormone / Q000627:therapeutic use; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000191:economics / Q000592:standards; D012216:Rheumatic Diseases / Q000188:drug therapy; D013997:Time Factors; D014807:Vitamin D / Q000627:therapeutic use; D014812:Vitamin K / Q000627:therapeutic use
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D005938:Glucocorticoids; D010281:Parathyroid Hormone; D014812:Vitamin K; D014807:Vitamin D; D012968:Etidronic Acid; D002118:Calcium; D000077557:Ibandronic Acid; D019386:Alendronate