Arnav Agarwal1, Jonathan D Adachi2,3. 1. Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 2. Department of Medicine, McMaster University, Hamilton, Ontario, Canada. jd.adachi@sympatico.ca. 3. Division of Rheumatology, Department of Medicine, McMaster University, 501-25 Charlton Ave E, Hamilton, ON, L8N 1Y2, Canada. jd.adachi@sympatico.ca.
Abstract
PURPOSE OF REVIEW: We aim to critically review recent recommendations regarding preventative strategies for glucocorticoid-induced osteoporosis and provide a summary of key evidence regarding available interventions. RECENT FINDINGS: Lifestyle optimization remains the hallmark of bone health preservation. Early initiation of anti-osteoporotic agents in the setting of glucocorticoid exposure is essential, guided by appropriate risk stratification. Recommendations for calcium and vitamin D intake optimization are well-supported across all risk strata. Bisphosphonates are the mainstay of pharmacological therapy. Newer agents such as denosumab and teriparatide have demonstrated comparative benefit in terms of incident fracture risk reduction and bone mineral density preservation, with comparable adverse events. With due consideration to cost, resource availability, and patient values and preferences, these agents may warrant use as the first-line agents in this setting. Glucocorticoid-induced osteoporosis remains preventable and warrants early and targeted evidence-based therapy.
PURPOSE OF REVIEW: We aim to critically review recent recommendations regarding preventative strategies for glucocorticoid-induced osteoporosis and provide a summary of key evidence regarding available interventions. RECENT FINDINGS: Lifestyle optimization remains the hallmark of bone health preservation. Early initiation of anti-osteoporotic agents in the setting of glucocorticoid exposure is essential, guided by appropriate risk stratification. Recommendations for calcium and vitamin D intake optimization are well-supported across all risk strata. Bisphosphonates are the mainstay of pharmacological therapy. Newer agents such as denosumab and teriparatide have demonstrated comparative benefit in terms of incident fracture risk reduction and bone mineral density preservation, with comparable adverse events. With due consideration to cost, resource availability, and patient values and preferences, these agents may warrant use as the first-line agents in this setting. Glucocorticoid-induced osteoporosis remains preventable and warrants early and targeted evidence-based therapy.
Entities:
Keywords:
Bone health; Glucocorticoid; Osteoporosis; Prevention; Steroid; Treatment
Authors: R F Laan; P L van Riel; L B van de Putte; L J van Erning; M A van't Hof; J A Lemmens Journal: Ann Intern Med Date: 1993-11-15 Impact factor: 25.391