11/15/05 Guidelines for prevention and treatment of corticosteroid- induced osteoporosisSummaryBackground - A major adverse effect of chronic systemic corticosteroid (CS) therapy is osteoporosis (OP) leading to increased bone loss and bone fragility with resultant increased frequency of fractures. Findings - Devogelaer et al of the Belgian Bone Club arrived at consensus statements about the prevention and treatment of CS-induced OP, based on their review of placebo-controlled studies. They concluded that OP prevention should be considered in all patients treated with at least 7.5 mg/day for at least 3 months. Non-pharmacologic measures such as weight bearing exercise and avoidance of smoking and heavy alcohol use are advisable. Supplemental calcium and vitamin D are first-line therapy; 1) monotherapy for those taking <7.5 mg prednisone/day or 2) as an adjuvant to other therapy when more intensive/prolonged CS therapy is in place or considered. More potent preventive measures include: 1) hormone replacement for females in early post-menopausal period; 2) treatment with bisphosphonates (alendronate, risedronate) is effective in reducing the frequency of fractures associated with CS-induced OP; 3) Calcitonin appears to have a protective effect on trabecular bone with less extensive evidence from studies. There is no evidence to support a greater efficacy of using a combination of 2 anti-resorptive drugs or a combination of anti-resorptive and anabolic drugs in the prevention of CS-induced OP. Reference
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