Bisphosphonates for steroid-induced osteoporosis

Area of Science:

• Pharmacology
• Endocrinology
• Orthopedics

Background:

• Corticosteroids are essential for inflammatory conditions but cause bone loss (glucocorticoid-induced osteoporosis - GIOP).
• Bisphosphonates are investigated for preventing and treating GIOP.
• This review updates previous findings on bisphosphonate efficacy and safety.

Purpose of the Study:

• To evaluate the benefits and harms of bisphosphonates for GIOP prevention and treatment in adults.
• To synthesize evidence from randomized controlled trials (RCTs).

Main Methods:

• Searched multiple databases (CENTRAL, MEDLINE, Embase, IPA) and trial registries up to April 2016.
• Included RCTs in adults on ≥5 mg/day steroids, comparing bisphosphonates (with/without calcium/vitamin D) to controls (calcium/vitamin D alone or placebo).
• Assessed fracture incidence, bone mineral density (BMD), serious adverse events, and withdrawals using Cochrane methodology and GRADE certainty assessment.

Main Results:

• High-certainty evidence shows bisphosphonates reduce vertebral fractures by 43% (NNTB 31) over 12-24 months.
• Moderate-certainty evidence indicates bisphosphonates stabilize/increase BMD at lumbar spine (3.5% absolute increase) and femoral neck (2.06% absolute increase).
• Low-certainty evidence suggests bisphosphonates may have little effect on nonvertebral fractures, serious adverse events, or withdrawals, with cautious interpretation due to potential bias.

Conclusions:

• Bisphosphonates are beneficial for reducing vertebral fracture risk and treating steroid-induced bone loss.
• Evidence supports bisphosphonate use for managing GIOP.
• Further research may be needed to clarify effects on nonvertebral fractures and long-term safety.