Overview of steroid-induced osteoporosis

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Saw this on another list and thought some of you might be interested.

Nina

Overview of glucocorticoid induced osteoporosisGlucocorticoids are widely used in the treatment of patients with chronic,noninfectious, inflammatory diseases. These include asthma, pulmonarydisease, rheumatoid arthritis and other connective tissue diseases,inflammatory bowel disease, and organ transplantation. However, these agentsare double-edged swords: Despite their beneficial anti-inflammatory andimmunosuppressive effects, adverse effects are frequent.Glucocorticoids have a profound effect on bone metabolism and are the majorcause of secondary osteoporosis. Skeletal wasting is most rapid during thefirst 6 months of glucocorticoid therapy, with trabecular bone more affectedthan cortical bone. Daily prednisone doses of 7.5 mg often result insignificant bone loss and increased fracture risk. Laan et al.[ 1 ]demonstrated an average loss of 8% of trabecular bone density and a 2% ofcortical bone density in the lumbar spine over a 20-week period in peopletreated with a mean dose of prednisone of 7.5 mg/day. A correspondingincrease in early fracture risk has been described, even independent ofchanges in BMD, as quickly as 3 months after beginning glucocorticoidtherapy[ 2 ],[ 3 ].Bone density in steroid-treated individuals, studied cross-sectionally, isrelated both to the duration of their glucocorticoid treatment and to thedose of these drugs. Scientists do not yet know whether there is a thresholddose of glucocorticoid below which osteopenia does not occur; alternate-dayglucocorticoid regimens have not been shown to produce less bone loss thandaily regimens. Even inhaled steroids appear to increase bone loss when usedchronically[ 4 ],[ 5 ],[ 6 ]. However, inhaled steroids pose less risk thanoral glucocorticoids. Regardless of the form of administration, using thelowest dose of glucocorticoids needed to control symptoms will help minimizebone loss. Initial rapid bone loss of 5% to 15% within the first 6 to 12 months Trabecular bone preferentially affected Bone loss potentially reversible with lowering of dose or cessation of steroidAccording to the American College of Rheumatology (ACR) Task Force onOsteoporosis Guidelines, the magnitude of GIOP suggests that the majority ofpatients receiving long-term glucocorticoid therapy have low bone mineraldensity (BMD), and that over one-fourth sustain osteoporotic fractures. Theprevalence of vertebral fractures in asthma patients receivingglucocorticoid therapy for at least 1 year is 11%, andglucocorticoid-treated patients with rheumatoid arthritis have an increasedincidence of fractures of the hip, rib, spine, leg, ankle, and foot. Thus,GIOP is an important clinical problem that involves both prevention andtreatment.http://www-cme.erep.uab.edu/onlineCourses/giop_rev1/contents1of1.asp