PREVENTION AND TREATMENT OF GLUCOCORTICOIDS-INDUCED OSTEOPOROSIS
Abstract
Glucocorticoid-induced osteoporosis is now a well-known form of the secondary osteoporosis, which increases the fracture risk in the patients and consequently the mortality and morbidity. Literature data show that more than 1% of the world's population is on continuous, oral therapy with these drugs. However, a large percentage of the patients (66%) who start the therapy have been deprived of adequate information on the duration of administration of these drugs and their adverse effects, like glucocorticoid-induced osteoporosis. Therefore, it is necessary to estimate the individual fracture risk in the patient at the beginning and during the therapy with glucocorticoids. Prevention should be undertaken in all patients and it includes general prevention and supplementation with calcium and vitamin D (or its synthetic analogs), where appropriate. The first line of the therapy involves administration of one of the three drugs from the group of bisphosphonates (alendronate, risedronate, and zoledronate) that inhibit resorption of bone. If they are ineffective, or patients have a higher risk of fractures, it is necessary to introduce teriparatide, which has the anabolic effects on the bone. During the implementation of the preventive measures and therapy for this type of osteoporosis, routine monitoring of patients is required and it includes regular measurement of the bone mineral density and assessment of treatment efficacy and adherence (especially during the use of bisphosphonates).
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