REVIEW - Prevention and treatment strategies for steroid-induced osteoporotic fractures

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Clin Rheumatol. 2007 Feb;26(2):144-53. Epub 2006 May 3.

Prevention and treatment strategies for glucocorticoid-induced

osteoporotic fractures.

Gourlay M, Franceschini N, Sheyn Y.

Department of Family Medicine, University of North Carolina, Chapel

Hill, Manning Drive, CB # 7595, Chapel Hill, NC 27599-7595, USA.

Glucocorticoids are the most common cause of drug-related

osteoporosis. We reviewed current evidence on risk factors for

glucocorticoid-induced osteoporosis (GIOP) and prevention and

treatment of GIOP-related fractures. Guidelines for GIOP management

published since 2000 were also reviewed. Significant bone loss and

increased fracture risk is seen with daily prednisone doses as low as

5 mg. Alternate-day glucocorticoid therapy can lead to similar bone

loss. No conclusive evidence exists for a safe minimum dose or

duration of glucocorticoid exposure. Physicians should consider risk

factors for involutional osteoporosis such as older age,

postmenopausal status, and baseline bone density measurements as they

assess patients for prevention or treatment of GIOP. Bisphosphonates

were reported to reduce GIOP-related vertebral fractures, but

inconclusive data exist for hip fractures associated with

glucocorticoid use. Hormone replacement therapy and parathyroid

hormone analogs are effective in preserving bone density in GIOP. The

risk of osteoporosis and fractures should be routinely assessed in

patients receiving glucocorticoid therapy. Effective prevention and

treatment options are available and can result in meaningful reduction

of GIOP-related morbidity and mortality. Current guidelines for GIOP

management recommend bisphosphonates, especially alendronate and

risedronate, as first-line agents for GIOP, and these guidelines

propose the preventive use of bisphosphonates early in the course of

glucocorticoid therapy in high-risk patient subgroups.

PMID: 16670825

http://www.ncbi.nlm.nih.gov/pubmed/16670825

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