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Corticosteroid-induced bone loss. Prevention and management

C Picado1, M Luengo

  • 1Department de Medicina, Hospital Clinic i Universitari, Facultat de Medicina, Barcelona, Spain.

Drug Safety
|November 1, 1996
PubMed
Summary

Corticosteroid therapy can cause serious osteoporosis. While many drugs aim to prevent bone loss, bisphosphonates and calcitonin show promise in increasing bone density, though fracture reduction remains unproven.

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Area of Science:

  • Endocrinology
  • Rheumatology
  • Pharmacology

Background:

  • Long-term corticosteroid therapy is a significant risk factor for osteoporosis.
  • Bone loss results from suppressed osteoblast activity and increased bone resorption.
  • Risk factors include smoking, excessive alcohol, amenorrhea, immobility, COPD, IBD, and hypogonadism.

Purpose of the Study:

  • To review the effectiveness of various pharmacological interventions for preventing corticosteroid-induced osteoporosis.
  • To identify optimal assessment and management strategies for patients on long-term corticosteroids.

Main Methods:

  • Review of published studies on drugs used to prevent corticosteroid-induced osteoporosis.
  • Analysis of factors increasing osteoporosis risk.
  • Assessment of diagnostic measures including bone density, calcium, calcifediol, and testosterone levels.

Main Results:

  • No pharmacological therapy has definitively reduced fracture rates in patients on continuous corticosteroids.
  • Bisphosphonates (pamidronic acid, etidronic acid) and calcitonin appear effective in increasing bone density.
  • Cholecalciferol, thiazide diuretics, estrogen, progesterone, and nandrolone show some positive but limited evidence.

Conclusions:

  • Lowest effective corticosteroid doses and topical formulations should be used.
  • Lifestyle modifications (calcium, vitamin D, exercise, smoking cessation, reduced alcohol) are crucial.
  • Hormone replacement and treatment of deficiencies (hypogonadism, vitamin D) are important.
  • High-risk patients may benefit from bisphosphonates, calcitonin, calcifediol, or calcitriol.

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