Review of New Guidelines for the Management of Glucocorticoid Induced Osteoporosis

Abstract

The chronic use of glucocorticoids results in osteoporosis. Several sets of guidelines have been published on the management of glucocorticoid induced osteoporosis (GIO). These guidelines vary on their focus and highlight different aspects of the current concepts in the management of GIO. In this current article, we summarize recent guidelines for management of GIO and highlight similarities and differences as well as address some of the controversies generated by these guidelines.

Osteoporosis

“…Different guidelines have been published for glucocorticoid-induced osteoporosis, which has a distinct pathophysiology. [24][25][26] WHO and NOF guidelines for men are concordant. Physicians must keep in mind the potent effect of androgen deprivation therapy used to treat prostate cancer on the subsequent rapid bone loss.…”

Long-term glucocorticoid effect on bone mineral density in patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency

“…A more precise estimation of endogenous cortisol production rate of 9-11 mg/m 2 /day (2) has recently led to the reduction in the dosage of GC replacement therapy (3). Adults with 21OHD are treated to limit symptoms of adrenocortical deficiency; however, slight GCs overtreatment is not so rare, mimicking glucocorticoid's excess features that include osteoporosis through multiple mechanisms (4,5). Previous reports on bone metabolism showed discrepant results in adult patients with 21OHD.…”

Prevention and treatment of glucocorticoid-induced osteoporosis

“…У прилог томе да не постоји безбедна доза ових лекова када је у питању ризик од настанка фрактура сугеришу докази да инхалационо и интраартикуларно примењени глукокортикоиди такође повећавају ризик за настанак фрактура, што води закључку да не постоји ни дневна доза, нити начин примене ових лекова који се могу сматрати безбедним. Ипак, већина међународних и националних водича за ГИОП, као и водич за Превенцију и лечење глукокортикоидима изазване остеопорозе у Србији, предлаже започињање лечења остеопорозе тек код дневне дозе преднизолона веће од 5mg (или еквивалентне дозе другог кортикостероида) 8,15 .…”