Glucocorticoid‐induced osteoporosis

In order to help educate clinicians and other health care providers on the effects of glucocorticoids on bone and to provide appropriate treatment options for this condition using published data, this review will briefly explore bone loss associated with glucocorticoids, explain differences in drug efficacy between the prevention and treatment of glucocorticoid‐induced osteoporosis, and examine the results of clinical drug trials. Based on current data, bisphosphonates appear to be the most effective therapy in both the prevention and treatment of glucocorticoid‐induced osteoporosis. If bisphosphonate therapy is contraindicated, calcitonin may be an effective alternative. For patients who have been treated but continue to lose bone, anabolic therapy, fluoride, or vitamin D analogs may be considered. While hormone replacement therapy has been widely evaluated in the prevention and treatment of primary osteoporosis, no efficacy data exists as far as prevention and limited information is available in the treatment of glucocorticoid‐induced osteoporosis. Bisphosphonates have shown significant treatment benefit. They increase bone mineral density and reduce the incidence of vertebral fractures. Bisphosphonates should be considered first line therapy for both the prevention and treatment of corticosteroid‐induced osteoporosis. Drug Dev. Res. 49:120–134, 2000. © 2000 Wiley‐Liss, Inc.