Prevention and Treatment of Bone Changes Associated with Exposure to Glucocorticoids

Abstract

Rheumatologic diseases are associated with a pro-inflammatory state which is thought to lead to many of the bone changes seen in treatment-naive patients. However, glucocorticoids remain a common treatment option for rheumatologic diseases and are known to have a negative impact on bone through direct effects on bone cells and indirect effects on calcium absorption. Despite the anti-inflammatory effect of glucocorticoids, fracture risk rises within the first three months of treatment. As such, osteoporosis prevention and treatment need to be considered in all patients started on chronic glucocorticoids (≥3 months of treatment). For very low risk patients, conservative management with non-pharmacologic strategies may be appropriate. For the moderate to high fracture risk patients treated with glucocorticoids, pharmacologic treatment with one of the four approved medications should be considered. The challenge of educating physicians and patients of the risks of glucocorticoid induced osteoporosis remain.

Effects of Epidural Steroid Injections on Bone Mineral Density and Bone Turnover Markers in Patients Taking Anti-Osteoporotic Medications

“…All the patients took more than one of these drugs during the follow-up period (Supplemental Table 4). In several studies, bisphosphonate was the most effective anti-osteoporotic medication for the treatment of glucocorticoid-induced osteoporosis and prevention of osteoporotic fracture (23)(24)(25). In the present study, 61 (83.6%) of the 73 patients in Group 1 and 231 (78.6%) of the 294 patients in Group 2 took bisphosphonate to treat osteoporosis.…”

Widely differing screening and treatment practice for osteoporosis in patients with inflammatory bowel diseases in the Swiss IBD cohort study

“…[ 35 , 37 , 38 ] During systemic glucocorticoid therapy calcium and vitamin D intake should be adequate, and depending on age, hormonal state, and BMD, additionally bisphosphonates or PTH analogues are recommended. [ 35 , 37 – 41 ] Several guidelines with similar recommendations exist for the treatment of patients with osteoporosis and IBD. [ 1 , 18 , 27 , 42 ] It remains unclear, how these guidelines are applied in clinical practice.…”

Foot and Ankle Insufficiency Fractures in Rheumatoid Arthritis

“…High doses and prolonged courses of glucocorticoids are a predictor, and the risk of insufficiency fractures is increased before changes in bone mineral density are seen. 19 However no patients in this case series had received multiple repeated courses of prednisolone (Table 1). Methotrexate-induced osteopathy has been described as an uncommon complication of long term high dose methotrexate use for maintenance chemotherapy treatment of malignancies in children, particularly acute lymphoblastic leukaemia.…”