Bisphosphonates for the prevention and treatment of corticosteroid-induced osteoporosis.

Corticosteroid-induced osteoporosis is a common occurrence among several different patient populations, including individuals undergoing therapy for rheumatoid arthritis, temporal arteritis, polymyalgia rheumatica, chronic lung disease, asthma and organ transplantation. The clinical trial data reviewed here demonstrate that bisphosphonate therapy can reverse, at least in part, established corticosteroid-induced osteoporosis, increase BMD, and prevent the development of new fractures. The consistency of results, with varying treatment regimens and in slightly different patient populations, provides strong support for the generalizability of these findings and for the use of bisphosphonates in corticosteroid-induced osteoporosis. These results are consistent with the findings from a recent meta-analysis, which reviewed data from 13 controlled clinical trials of bisphosphonate use in corticosteroid-induced osteoporosis. In that analysis, 1 year of bisphosphonate therapy produced a significant increase in BMD at the lumbar spine (average difference in BMD between treated and control groups of 4.0%) and femoral neck (average BMD difference of 2.1% between treated and control patients). Bisphosphonate therapy, therefore, appears to be an effective, well-tolerated means of reducing the risk of bone fractures among patients treated with corticosteroids.