Advances in treatment of glucocorticoid-induced osteoporosis

Abstract

Purpose of Review To summarize monitoring, prevention, and treatment options of glucocorticoid-induced osteoporosis for patients on chronic glucocorticoid therapy. Recent Findings Recent meta-analyses highlight the efficacy of bisphosphonate use in improving bone mineral density and in reducing vertebral fractures in the setting of long term glucocorticoid use. A new study has now shown that alendronate also reduces the risk of hip fracture in glucocorticoid use. Emerging data indicate that teriparatide and denosumab also reduce the risk of osteoporotic fracture in glucocorticoid-induced osteoporosis. Summary Glucocorticoid use is a leading cause of secondary osteoporosis; however, patients at risk of glucocorticoid-induced osteoporosis are often not evaluated or treated in a timely manner. Patients on a dose equivalent of 2.5mg prednisone or greater for 3 months or longer duration should have their fracture risk assessed. Those at moderate or high risk should start bisphosphonate therapy, or if contraindicated, a second line agent such as teriparatide or denosumab.

Current approach to diagnosis and management of retroperitoneal fibrosis

“…Prophylaxis for osteoporosis with bone-modifying agents, such as bisphosphonate and denosumab, in addition to calcium and vitamin D 3 supplementation, should be started in patients with low BMD. 39,40 Infections, such as PJP, herpes zoster, tuberculosis and HBV reactivation, pose significant dangers during glucocorticoid therapy. Before the start of glucocorticoid treatment, the infection status of herpes zoster, tuberculosis and HBV should be screened by serological examinations.…”

“…BMD should be measured by dual‐energy X‐ray absorptiometry before starting the glucocorticoid treatment. Prophylaxis for osteoporosis with bone‐modifying agents, such as bisphosphonate and denosumab, in addition to calcium and vitamin D 3 supplementation, should be started in patients with low BMD 39,40 . Infections, such as PJP, herpes zoster, tuberculosis and HBV reactivation, pose significant dangers during glucocorticoid therapy.…”

Pharmaceutical management of bone catabolism: the bisphosphonates

“…Risedronate and alendronic acid are first choices and where these drugs are contraindicated, second line agents such as denosumab or teriparatide could be considered. 33 Because of limited information on the advantages BP intervention in patients taking glucocorticoids, the American College of Rheumatology advises vitamin D and calcium supplementation without BP administration in patients with a low fracture risk. 34 Pamidronate and alendronic acid have been shown to reduce the markers of bone resorption during skeletal immobilisation and their protective influence on the skeleton, and reduction of hypercalcaemia and nephrolithiasis is promising.…”

“…Renal function can rapidly deteriorate in patients on IV BPs particularly if the creatinine clearance and glomerular filtration rates are below 30 ml/min 32,33 and 35 ml/min. respectively.…”

Osteoporose induzida por glicocorticoides: expressão salivar de biomarcadores ósseos em pacientes submetidos à corticoterapia prolongada e sua correlação radiomorfométrica

“…No entanto, apesar da melhora do quadro sistêmico e qualidade de vida desses pacientes, os efeitos colaterais desencadeados pela administração prolongada de tais fármacos, se mostram substancialmente presentes. Destes, salienta-se o acometimento do metabolismo ósseo e desenvolvimento de osteoporose induzida por glicocorticoides (Grando, 2012;Ghodsi et al, 2014;Nanes, 2017).…”