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An update on glucocorticoid-induced osteoporosis
1Division of Rheumatology, University of California at San Francisco, San Francisco, California, USA. nelane@itsa.ucsf.edu
Rheumatic Diseases Clinics of North America
|April 5, 2001
Summary
Glucocorticoid therapy causes rapid bone loss, especially in trabecular bone. Early calcium, vitamin D, and antiresorptive agents are crucial for preventing glucocorticoid-induced osteoporosis.
Area of Science:
- Endocrinology
- Metabolic Bone Disease
- Pharmacology
Background:
- Glucocorticoids rapidly induce bone loss, primarily affecting trabecular bone.
- Multiple metabolic pathways are altered by glucocorticoid treatment.
Purpose of the Study:
- To outline early preventive strategies for glucocorticoid-induced bone loss.
- To recommend specific calcium, vitamin D, and antiresorptive therapies.
Main Methods:
- Literature review and expert opinion on managing glucocorticoid-induced bone loss.
- Recommendations for supplementation and pharmacotherapy based on treatment duration and patient history.
Main Results:
- Calcium (1500 mg) and Vitamin D (400-800 IU/d) are recommended for all initiating prednisone (≥7.5 mg/d).
- Antiresorptive agents are advised for treatment >4 weeks or in patients with existing osteoporosis on lower doses.
- Bone mineral density measurements can aid risk assessment and monitoring.
Conclusions:
- Early intervention with supplementation and antiresorptive agents is critical for preventing glucocorticoid-induced bone loss.
- Exercise and management of hypercalciuria are important adjuncts.
- Anabolic agents may offer future treatment options for refractory cases.