Skip to main content
Log in

Prophylaxe und Therapie der Glukokortikoid-induzierten Osteoporose – rezente Leitlinien im Überblick

Prophylaxis and therapy of the glucocorticoid-induced osteoporosis – a review of recent guidelines

  • Übersicht
  • Published:
Wiener klinische Wochenschrift Aims and scope Submit manuscript

Summary

Several international guidelines for treatment and prophylaxis of glucocorticoid-induced osteoporosis (GIO) have been published. Consistent with the development of new therapeutic agents, a different approach to treatment can be recognized depending on the year of publication. Also, new insights for the postmenopausal osteoporosis leave their marks on recent guidelines. The working committee on Osteology of the Austrian Society for Rheumatology and Rehabilitation (ÖGR) sifted through actual guidelines and recent literature on the topic to develop recommendations for the prophylaxis and treatment of the GIO.

Zusammenfassung

Mehrere internationale Leitlinien zur Therapie und Prophylaxe der Glukokortikoid-induzierten Osteoporose (GIO) sind verfügbar. Die Unterschiede in den verschiedenen Empfehlungen sind nachvollziehbar, wenn man die zum jeweiligen Publikationsdatum vorliegenden wissenschaftlichen Daten berücksichtigt. Einige neue Erkenntnisse zur postmenopausalen Osteoporose fließen in rezentere Leitlinien zur GIO ein. Nach Bearbeitung aktueller Leitlinien und rezenter Literatur zu diesem Thema hat sich der Arbeitskreis Osteologie der österreichischen Gesellschaft für Rheumatologie und Rehabilitation (ÖGR) entschlossen, nationale Empfehlungen zur Prophylaxe und Therapie der GIO zu geben.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Referenzen

  • Gorter SL, Bijlsma JW, Cutolo M, et al. Current evidence for the management of rheumatoid arthritis with glucocorticoids: a systematic literature review informing the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis 2010;69(6):1010–4

    Article  PubMed  CAS  Google Scholar 

  • Ghosh P, Borg FA, Dasgupta B. Current understanding and management of giant cell arteritis and polymyalgia rheumatica. Expert Rev Clin Immunol. 2010;6(6):913–28

    Article  PubMed  CAS  Google Scholar 

  • Lane NE, Yao W. Glucocorticoid-induced bone fragility. Ann N Y Acad Sci. 2010;1192:81–3

    Article  PubMed  CAS  Google Scholar 

  • Morris HA, Need AG, O'Loughlin PD, et al. Malabsorption of calcium in corticosteroid-induced osteoporosis. Calcif Tissue Int 1990;46(5):305–8

    Article  PubMed  CAS  Google Scholar 

  • Schakman O, Gilson H, Thissen JP. Mechanisms of glucocorticoid-induced myopathy. J Endocrinol 2008;197(1):1–10

    Article  PubMed  CAS  Google Scholar 

  • Dalle Carbonare L, Arlot ME, Chavassieux PM et al. Comparison of trabecular bone microarchitecture and remodeling in glucocorticoid-induced and postmenopausal osteoporosis. J Bone Miner Res 2001;16(1):97–103

    Article  PubMed  CAS  Google Scholar 

  • Steinbuch M, Youket TE, Cohen S. Oral glucocorticoid use is associated with an increased risk of fracture. Osteoporos Int 2004;15(4):323–8

    Article  PubMed  CAS  Google Scholar 

  • Van Staa TP, Leufkens HG, Abenhaim L, et al. Use of oral corticosteroids and risk of fractures. J Bone Miner Res 2000;15(6):993–1000

    Article  PubMed  CAS  Google Scholar 

  • Shenstone BD, Mahmoud R, Woodward R, et al. Longitudinal bone mineral density changes in early rheumatoid arthritis. Br J Rheumatol 1994;33: 541–5

    Article  PubMed  CAS  Google Scholar 

  • Kanis JA, Stevenson M, McCloskey EV, et al. Glucocorticoid-induced osteoporosis: a systematic review and cost-utility analysis. Health Technol Assess 2007;11(7):iii–iv, ix–xi, 1–231

    PubMed  CAS  Google Scholar 

  • Glucocorticoid induced osteoporosis: guidelines for prevention and treatment (Royal College of Physicians, London, 2002). www.rcplondon.ac.uk/pubs/books/glucocorticoid/

  • Prophylaxe, Diagnostik und Therapie der Glukokortikoid-induzierten Osteoporose. DVO-Leitlinien 2006. www.dv-osteologie.org/

  • Hoes JN, Jacobs JW, Boers M, et al. EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis 2007;66(12):1560–7

    Article  PubMed  CAS  Google Scholar 

  • DVO-Leitlinie 2009 zur Prophylaxe, Diagnostik und Therapie der Osteoporose bei Erwachsenen. www.dv-osteologie.org/dvo_leitlinien/dvo-leitlinie-2009

  • Grossman JM, Gordon R, Ranganath VK, et al. American College of Rheumatology recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res (Hoboken) 2010;62(11):1515–26

    Article  Google Scholar 

  • Chikada N, Imaki T, Hotta M, et al. An assessment of bone mineral density in patients with Addison's disease and isolated ACTH deficiency treated with glucocorticoid. Endocr J 2004;51:355–360

    Article  PubMed  CAS  Google Scholar 

  • van Staa TP, Geusens P, Pols HA, et al. A simple score for estimating the long-term risk of fracture in patients using oral glucocorticoids. QJM 2005;98(3):191–8

    Article  PubMed  Google Scholar 

  • Hunt SA, Abraham WT, Chin MH, et al. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to update the 2001 guidelines for the evaluation and management of heart failure). Developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 2005;112:e154–235

    Article  PubMed  Google Scholar 

  • American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 update. Arthritis Rheum 2001;44:1496–503

    Article  Google Scholar 

  • www.sheffield.ac.uk/FRAX/

  • Eastell R, Reid DM, Compston J, et al. A UK Consensus Group on management of glucocorticoid-induced osteoporosis: an update. J Intern Med 1998;244:271–92

    Article  PubMed  CAS  Google Scholar 

  • Compston JE, Audran M, Avouac B, et al. Recommendations for the registration of agents used in the prevention and treatment of glucocorticoid-induced osteoporosis. Calcif Tissue Int 1996;59:323–7

    Article  PubMed  CAS  Google Scholar 

  • Adachi JD, Bensen WG, Brown J, et al. Intermittent etidronate therapy to prevent corticosteroid-induced osteoporosis. N Engl J Med 1997;337:382–7

    Article  PubMed  CAS  Google Scholar 

  • Adachi JD, Saag KG, Delmas PD, et al. Two-year effects of alendronate on bone mineral density and vertebral fracture in patients receiving glucocorticoids: a randomized, double-blind, pla-cebo-controlled extension trial. Arthritis Rheum 2001;44(1):202–11

    Article  PubMed  CAS  Google Scholar 

  • Wallach S, Cohen S, Reid DM, et al. Effects of risedronate treatment on bone density and vertebral fracture in patients on corticosteroid therapy. Calcif Tissue Int 2000;67:277–85

    Article  PubMed  CAS  Google Scholar 

  • Reid DM, Adami S, Devogelaer JP, et al. Risedronate increases bone density and reduces vertebral fracture risk within one year in men on corticosteroid therapy. Calcif Tissue Int 2001;69(4):242–7

    Article  PubMed  CAS  Google Scholar 

  • Arznei und Vernunft. Osteoporose - Knochenbruch-Krankheit, 3. Auflage Mai 2010

  • Bultink IE, Lems WF, Kostense PJ, et al. Prevalence of and risk factors for low bone mineral density and vertebral fractures in patients with systemic lupus erythematosus. Arthritis Rheum 2005;52:2044–50

    Article  PubMed  Google Scholar 

  • Bolland MJ, Avenell A, Baron JA, et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 2010;341:c3691

    Article  PubMed  Google Scholar 

  • Reid DM, Devogelaer JP, Saag K, et al. HORIZON investigators. Zoledronic acid and risedronate in the prevention and treatment of glucocorticoid-induced osteoporosis (HORIZON): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet 2009;373(9671):1253–63

    Article  PubMed  CAS  Google Scholar 

  • Saag KG, Zanchetta JR, Devogelaer JP, et al. Effects of teriparatide versus alendronate for treating glucocorticoid-induced osteoporosis: thirty-six-month results of a randomized, double-blind, controlled trial. Arthritis Rheum 2009;60(11):3346–55

    Article  PubMed  CAS  Google Scholar 

  • Stoch SA, Saag KG, Greenwald M, et al. Once-weekly oral alendronate 70 mg in patients with glucocorticoid-induced bone loss: a 12-month randomized, placebo-controlled clinical trial. J Rheumatol 2009;36(8):1705–14

    Article  PubMed  CAS  Google Scholar 

  • Engvall IL, Svensson B, Tengstrand B, et al. Better Anti-Rheumatic FarmacO Therapy Study Group. Impact of low-dose prednisolone on bone synthesis and resorption in early rheumatoid arthritis: experiences from a two-year randomized study. Arthritis Res Ther 2008;10(6):R128

    Article  PubMed  Google Scholar 

  • Chopin F, Garnero P, le Henanff A, et al. Long-term effects of infliximab on bone and cartilage turnover markers in patients with rheumatoid arthritis. Ann Rheum Dis 2008;67(3):353–7

    Article  PubMed  CAS  Google Scholar 

  • Bone HG, Hosking D, Devogelaer JP, et al. Alendronate Phase III Osteoporosis Treatment Study Group. Ten years' experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med 2004;350(12):1189–99

    Article  PubMed  CAS  Google Scholar 

  • www.fda.gov/Drugs

  • McNicholl DM, Heaney LG. The safety of bisphosphonate use in pre-menopausal women on corticosteroids. Curr Drug Saf 2010;5(2):182–7

    Article  PubMed  CAS  Google Scholar 

  • www.perinatology.com

  • Kimmel DB. Mechanism of action, pharmacokinetic and pharmacodynamic profile and clinical applications of nitrogen-containing bisphosphonates. J Dent Res. 2007;86(11):1022–33 (http://jdr.sagepub.com/content/86/11/1022)

    Google Scholar 

  • Hoes JN, Jacobs JW, Hulsmans HM, et al. High incidence rate of vertebral fractures during chronic prednisone treatment, in spite of bisphosphonate or alfacalcidol use. Extension of the alendronate or alfacalcidol in glucocorticoid-induced osteoporosis-trial. Clin Exp Rheumatol. 2010;28(3):354–9

    PubMed  Google Scholar 

  • Barnabe C, Hanley DA. Effect of tumor necrosis factor alpha inhibition on bone density and turnover markers in patients with rheumatoid arthritis and spondyloarthropathy. Semin Arthritis Rheum 2009;39(2):116–22

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to Bernhard Rintelen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rintelen, B., Bobacz, K., Höfle, G. et al. Prophylaxe und Therapie der Glukokortikoid-induzierten Osteoporose – rezente Leitlinien im Überblick. Wien Klin Wochenschr 123, 633–644 (2011). https://doi.org/10.1007/s00508-011-0042-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00508-011-0042-8

Keywords

Schlüsselwörter

Navigation