Glucocorticoid-induced osteoporosis in rheumatic diseases.
The aim of this article is to review rheumatological diseases that are associated with glucocorticoid-induced osteoporosis or fractures and to perform a critical analysis of the current guidelines and treatment regimens. The electronic database MEDLINE was searched using the date range of July 1986 to June 2009 and the following search terms: osteoporosis, bone mineral density, fractures, systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, vasculitis, juvenile rheumatoid arthritis, juvenile idiopathic arthritis and juvenile dermatomyositis. Osteopenia and osteoporosis respectively account for 1.4 to 68.7% and 5.0 to 61.9% of adult rheumatological diseases. Among juvenile rheumatological disorders, the frequency of low bone mass ranges from 38.7 to 70%. In general, fracture rates vary from 0 to 25%. Although glucocorticoid-induced osteoporosis has a high rate of prevalence among rheumatic diseases, a relatively low number of patients on continuous glucocorticoid treatment receive adequate diagnostic evaluation or preventive therapy. This deficit in patient care may result from a lack of clear understanding of the attributed risks by the patients and physicians, the high complexity of the treatment guidelines and poor patient compliance.
Rheumatology Division, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. rosamariarp@yahoo.com
Rosa Maria Rodrigues
RM
Pereira
Jozélio Freire de
JF
Carvalho
Ernesto
E
Canalis
D015519:Bone Density / Q000187:drug effects; D050723:Fractures, Bone / Q000139:chemically induced; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D010024:Osteoporosis / Q000139:chemically induced* / Q000517:prevention & control; D012216:Rheumatic Diseases / Q000188:drug therapy*
D005938:Glucocorticoids
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