Interní Med. 2007; 9(7): 324-327

Glucocorticoid-induced osteoporosis

MUDr. Vít Zikán Ph.D

III. interní klinika VFN a 1. LF UK, Praha

Glucocorticoid-induced osteoporosis (GIOP) is the most common cause of secondary osteoporosis. Glucocorticoid (GC) have adverse skeletal effects, mainly through inhibitions in bone formation and osteocyte apoptosis. Epidemiological studies have found that the increases in the risk of vertebral fractures in oral GC users are dose dependent and occur within 3-6 months of starting GC therapy. Clinically, it is important to note that fracture risk is increased even at low doses of GC. Primary prevention of bone loss and fractures should be considered in all high-risk patients taking oral GC at daily doses of > 2,5 mg prednisone equivalent for 3 months or more. Intervention tresholds for therapy should not be based on a fixed T-score of BMD but on absolute long-term fracture probabilities. All patients who start on oral GC therapy should receive calcium and vitamin D. Patients with a higher risk of fracture should receive a bisphosphonate. Anabolic agents, such as parathyroid hormone, stimulate bone formation and can restore bone mass in GIOP.

Keywords: glucocorticoids, osteoporosis, fracture risk, treatment

Published: December 18, 2007  Show citation