Abstract
Glucocorticoid‐induced osteoporosis is a common clinical problem. This review briefly summarizes the pathogenesis of this disorder. All relevant studies on the prevention and treatment of glucocorticoid‐induced osteoporosis are discussed more in detail. As the results of these studies are inconclusive, a proposal for a practical approach of the individual patient is formulated.
Similar content being viewed by others
References
Cushing H. Basophil adenomas of the pituitary body and their clinical manifestations (pituitary basophilism) Bull Johns Hopkins Hosp 1932;50:137–95.
Curtiss PH, Clark WS, Herndon CH. Vertebral fractures resulting from prolonged cortisone and corticotrophin therapy. JAMA 1954;156:467–9.
Adinoff AD, Hollister JR. Steroid-induced fractures and bone loss in patients with asthma. N Engl J Med 1983; 309:265–8.
Lukert BP, Raisz LG. Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Int Med 1990;112:352–64
Laan RFJM, Van Riel PLCM, Van de Putte LBA, Van Erning LJTO, Van 't Hof MS, Lemmens AM. Low-dose prednisone induces rapid reversible axial bone loss in patients with rheumatoid arthritis. Ann Intern Med 1993;119:963–8.
LoCascio V, Boucci E, Imbimbo B, et al. Bone loss in response to long-term glucocorticoid therapy. Bone Miner 1990;8:39–51.
Gennari C, Civitelli R. Glucocorticoid-induced osteoporosis. Clinics Rheum Dis 1986;12:143–6.
Reid IR, King AR, Alexander CJ, Ibbertson HK. Prevention of steroid-induced osteoporosis with (3-amino-hydroxypropylidene)-1,1-diphosphonate (APD). Lancet 1988;i:143–6.
Sambrook P, Birmingham J, Kempler S, et al. Prevention of corticosteroid osteoporosis-a comparison of calcium, calcitriol and calcitonin. N Engl J Med 1993;328:1747–52.
Dyckman TR, Gluck OS, Murphy WA, Hahn TJ, Hahn BH. Evaluation of factors associated with glucocorticoid-induced osteopenia in patients with rheumatic diseases. Arthritis Rheum 1985;28:361–8.
Reid IR, Heap SW. Determinants of of vertebral mineral density in patients receiving long-term glucocorticoid therapy. Arch Int Med 1990;150:2545–8.
Eastell R. Management of corticosteroid-induced osteoporosis.J Int Med 1995;237:439–47.
Papapoulos SE. Glucocorticoid-induced osteoporosis. In Papapoulos SE et al., eds. Osteoporosis 1996: proceedings of the 1996 World Congress on Osteoporosis. Amsterdam: Elsevier, 1996:359–67.
Gough AKS, Lilley J, Eyre S, Holder RL, Emery P. Generalised bone loss in patients with early rheumatoid arthritis. Lancet 1994;344:23–6.
Eggelmeijer F, Papapoulos SE, Van Paassen HC, et al. Increased bone mass with pamidronate treatment in rheumatoid arthritis. Arthritis Rheum 1996;39:396–402.
Lems WF, Jacobs JWG, VanRijn HJM, Bijlsma JWJ. Changes in calcium and bone metabolism during treatment with low dose prednisone in young, healthy male volunteers. Clinical Rheum 1995;14:420–4.
Messina OD, Barreira JC, Zanchetta JR, et al. Effect of low doses of deflazacort vs prednisone on bone mineral content in premenopausal rheumatoid arthritis. J Rheumatol1992;19:1520–6.
Gray RE, Doherty SM, Galloway J, Coulton L, de Broe M, Kanis JA. A double-blind study of deflazacort and prednisone in patients with chronic inflammatory disorders. Arthritis Rheum 1991;34:287–95.
Krogsgaard MR, Thamsborg G, Lund B. Changes in bone mass during low dose corticosteroid treatment in patients with polymyalgia rheumatica: a double blind, prospective comparison between prednisolone and deflazacort. Ann Rheum Dis 1996;55: 143–6.
Hahn TJ, Halstead LR, Teitelbaum SL. Altered mineral metabolism in glucocorticoid-induced osteopenia: Effects of 25-hydroxyvitamin D administration. J Clin Invest 1979;64:655–65.
Bijlsma JWJ, Raymakers JA, Mosch C, et al. Effect of oral calcium and vitamin D on glucocorticoid-induced osteoporosis. Clin Exp Rheum 1988;6:113–9.
Adachi JD, Bensen WG, Bianchi F, et al. Vitamin D and calcium in the prevention of corticosteroid induced osteoporosis: a 3 year follow-up. J Rheumatol 1996;23:995–1000.
Buckley LM, Leib ES, Cartularo KS, Vacek PM, Cooper SM. Calcium and vitamin D3 Supplementation prevents bone loss in the spine secondary to low-dose corticosteroids in patients with rheumatoid arthritis. Ann In tern Med 1996;125:961–8.
Ringe JD, Welzel D, Schmid K. Therapy of corticosteroid-induced osteoporosis. Eur J Clin Pharmacol 1987;33(1):35–9.
Montemurro L, Schiraldi G, Fraioli P, Tosi G, Riboldi A, Rizzato G. Prevention of corticosteroid-induced osteoporosis with salmon calcitonin in sarcoid patients. Calc Tiss Int 1991;49:71–6.
Lukert BP, Johnson BE, Robinson RG. Estrogen and progesterone replacement therapy reduces glucocorticoid-induced bone loss.J Bone Miner Res 1992;7:1063–9.
Hall GM, Daniels M, Doyle DV, Spector TD. Effect of hormone replacement therapy on bone mass in rheumatoid arthritis patients treated with and without corticosteroids. Arthritis Rheum 1994;37:1499–1505.
Reid IR, Heap SW, King AR, Ibbertson HK. Two-year follow-up of bisphosphonate (APD) treatment in steroid osteoporosis. Lancet 1988;ii:1144.
Gallagher SJ, Fenner JAK, Anderson K, et al. Intravenous pamidronate in the treatment of osteoporosis associated with corticosteroid-dependent lung disease: an open pilot study. Thorax 1992;47:932–6.
Mulder H, Struys A. Intermittent cyclical etidronate in the prevention of steroid-induced bone loss. Br J Rheumatol 1994;33:348–50.
Adachi JD, Cranney A, Goldsmith CH, et al. Intermittent cyclic therapy with etidronate in the prevention of corticosteroid-induced bone loss. Can J Rheumatol 1994;21:1922–6.
Adachi JD, Bensen WG, Brown J, et al. Intermittent etidronate therapy to prevent corticosteroid-induced osteoporosis. New Engl J Med 1997;337:382–7.
Diamond T, McGuigan L, Barbagallo S, Bryant C. Cyclical etidronate plus ergocalciferol prevents glucocorticosteroid-induced bone loss in postmenopausal women. Am J Med 1995;98:459–63.
Struys A, Snelder AA, Mulder H. Cyclical etidronate reverses bone loss of the spine and proximal femur in patients with established corticosteroid-induced osteoporosis. Am J Med 1995;99:235–42.
Geusens P, Dequeker J, Pack S, et al. Etidronate increases bone density in the spine and the hip of postmenopausal women on chronic corticosteroid treatment: a double-blind controlled study. Bone 1997;20:S9.
Adachi JD, Chines AA, Stephenson GF, Pack S. Intermittent cyclical therapy with etidronate in the prevention of corticosteroid induced osteoporosis. Bone 1997;20:S92.
Pitt P, Li F, Bloom B, et al. A double-blind placebo controlled study to determine the effects of intermittent cyclical etidronate on bone mineral density in patients on long-term corticosteroid treatment. Bone 1997;20:S100.
Eastell R, Devogelaer JP, Peel NFA, et al. A double-blind placebo-controlled study to determine the effects of risedronate on bone loss in glucocorticoid-treated rheumatoid arthritis. In Papapoulos SE et al., eds. Osteoporosis 1996: proceedings of the 1996 World Congress on Osteoporosis. Amsterdam: Elsevier, 1996:391–3.
Saag K, Emkey R, Gruber B, et al. Alendronate for the management of glucocorticoid-induced osteoporosis: results of a multicenter U.S. study. Arthritis Rheum 1997;40:9S abstract 630.
Poubelle PE, Adachi J, Hawkins F, et al. Alendronate increases bone mineral density in patients on glucocorticoid therapy: results of a multinational study. Arthritis Rheum 1997;40:9S abstract 1774.
Need AG. Corticosteroids and osteoporosis. Australian and New Zealand J Med 1987;17:267–72.
Adami S, Fossaluza V, Rossini M, et al. The prevention of corticosteroid-induced osteoporosis with nandrolone decaonate. Bone Miner 1991;15:72–81.
Bayley TA, Muller C, Harrison J, Basualdo J, Sturtridge W, Josse R. The long-term treatment of steroid-osteoporosis with fluoride. J Bone Miner Res 1990;5(suppl 1):157–61.
Greenwald M, Brandli D, Spector S, Silverman S, Golde G. Corticosteroid-induced osteoporosis: effect of a treatment with slow-release sodium fluoride. Osteoporosis Int 1992;2:303–4.
Rizzoli R, Chevalley T, Slosman DO, Bonjour JP. Sodium monofluorophosphate increases vertebral bone mineral density in patients with corticosteroid-induced osteoporosis. Osteoporosis Int 1995;5:39–46.
Lems WF, Jacobs JWG, Bijlsma JWJ, et al. Effect of sodium-fluoride in the prevention of corticosteroid-induced osteoporosis. Arthritis Rheum 1996;39:1144.
Reid IR, Wattie DJ, Evans MC, Stapleton JP. Testosterone therapy in glucocorticoid-treated men. Arch Int Med 1996;156:1173–7.
Grecu EO, Weinshelbaum A, Simmons R. Effective therapy of glucocorticoid-induced osteoporosis with medroxyprogesterone acetate. Calcif Tiss Int 1990;46:294–9.
Lems WF, Jacobs JWG, Bijlsma JWJ, et al. Is addition of sodium fluoride to cyclical etidronate beneficial in the treatment of corticosteroid induced osteoporosis? Ann Rheum Dis 1997;56:357–63.
American College of Rheumatology task force on osteoporosis guidelines. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheum 1996;39;1791–1801.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Eggelmeijer, F. Prevention and treatment of glucocorticoid‐induced osteoporosis. Pharm World Sci 20, 193–197 (1998). https://doi.org/10.1023/A:1008654008470
Issue Date:
DOI: https://doi.org/10.1023/A:1008654008470