Management of glucocorticoid-induced osteoporosis

Bone therapy; Fracture; FRAX; Glucocorticoid; Osteoporosis; Bone Density; Bone Density Conservation Agents; Calcium; Clinical Trials as Topic; Dietary Supplements; Diphosphonates; Disease Management; Fractures, Bone; Glucocorticoids; Humans; Vitamin D

Abstract :

[en] This review summarizes the available evidence-based data that form the basis for therapeutic intervention and covers the current status of glucocorticoid-induced osteoporosis (GIOP) management, regulatory requirements, and risk-assessment options. Glucocorticoids are known to cause bone loss and fractures, yet many patients receiving or initiating glucocorticoid therapy are not appropriately evaluated and treated. An European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis workshop was convened to discuss GIOP management and to provide a report by a panel of experts. An expert panel reviewed the available studies that discussed approved therapeutic agents, focusing on randomized and controlled clinical trials reporting on bone mineral density and/or fracture risk of at least 48 weeks' duration. There is no evidence that GIOP and postmenopausal osteoporosis respond differently to treatments. The FRAX algorithm can be adjusted according to glucocorticoid dose. Available antiosteoporotic therapies such as bisphosphonates and teriparatide are efficacious in GIOP management. Several other agents approved for the treatment of postmenopausal osteoporosis may become available for GIOP. It is advised to stop antiosteoporotic treatment after glucocorticoid cessation, unless the patient remains at increased risk of fracture. Calcium and vitamin D supplementation as an osteoporosis-prevention measure is less effective than specific antiosteoporotic treatment. Fracture end-point studies and additional studies investigating specific subpopulations (pediatric, premenopausal, or elderly patients) would strengthen the evidence base and facilitate the development of intervention thresholds and treatment guidelines. © Springer Science+Business Media, LLC 2012.

Disciplines :

General & internal medicine

Author, co-author :

Rizzoli, R.; Service of Bone Diseases, Faculty of Medicine, Geneva University Hospitals, 1211 Geneva 14, Switzerland

Adachi, J. D.; Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, ON, Canada

Cooper, C.; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom, NIHR Musculoskeletal Biomedical Research Unit, Institute of Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom

Dere, W.; Amgen, Uxbridge, United Kingdom

Devogelaer, J. P.; Arthritis Unit UCL5390, Université Catholique de Louvain, 1200 Brussels, Belgium

Diez-Perez, A.; Department of Internal Medicine, Hospital del Mar-IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain, RETICEF, Instituto Carlos III, Barcelona, Spain

Kanis, J. A.; Centre for Metabolic Bone Diseases (WHO Collaborating Centre), University of Sheffield Medical School, Sheffield, United Kingdom

Laslop, A.; AGES PharmMed, Vienna, Austria

Mitlak, B.; Lilly Research Labs, Eli Lilly and Company, Indianapolis, IN, United States

Papapoulos, S.; Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, Netherlands

More authors (4 more)

Language :

English

Title :

Management of glucocorticoid-induced osteoporosis

Publication date :

2012

Journal title :

Calcified Tissue International

ISSN :

0171-967X

eISSN :

1432-0827

Publisher :

Springer, Germany

Volume :

Issue :

Pages :

225-243

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 18 October 2013

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