REVIEW - Prevention and treatment of steroid-induced osteoporosis

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Yonsei Med J. 2005 Aug 31;46(4):456-63.

Prevention and treatment of corticosteroid-induced osteoporosis.

Iwamoto J, Takeda T, Sato Y.

Department of Sports Medicine, Keio University School of Medicine, 35

Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. jiwamoto@...

Osteoporosis is one of the most serious complications of corticosteroid

treatment. Loss of bone mineral density (BMD) and fractures occur early in

the course of corticosteroid treatment, and thus early recognition of

fracture risk and effective intervention based on evidence-based-medicine

(EBM) are needed. A study of meta-analysis representing the highest level in

a hierarchy of evidence showed that when the outcome measure of interest was

limited to changes in lumbar spine BMD, bisphosphonates were the most

effective of the agents studied in comparison with no therapy or treatment

with calcium, and were also more efficacious than either vitamin D or

calcitonin; the efficacy of bisphosphonates was enhanced when used in

combination with vitamin D. Randomized controlled trials (RCTs) representing

the second level in a hierarchy of evidence showed that bisphosphonates

stabilized BMD not only in the lumbar spine, but also in the hip, and that

parathyroid hormone (PTH) markedly increased lumbar spine BMD. According to

the EBM, bisphosphonates and possibly PTH are suggested to be the most

efficacious for preserving BMD. The efficacy of these agents in reducing the

incidence of vertebral fractures in patients exposed to corticosteroids

remains to be established in meta-analysis studies, although some RCTs have

demonstrated the anti-fracture effects of etidronate, alendronate, and

risedronate in the spine. Further RCTs of fracture prevention conducted on a

large number of patients and their meta-analysis are needed to confirm the

efficacy of bisphosphonates, PTH, or other agents in preventing vertebral

and nonvertebral fractures.

PMID: 16127768

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=16127768 & itool=iconfft & query_hl=2 & itool=pubmed_DocSum

Full text (PDF):

http://www.eymj.org/2005/pdf/08456.PDF

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