Steroid-induced osteoporosis is osteoporosis arising due to use of glucocorticoids (steroid hormones) - analogous to Cushing's syndrome and involving mainly the axial skeleton. The synthetic glucocorticoid prescription drug prednisone is a main candidate after prolonged intake. Bisphosphonates are beneficial in reducing the risk of vertebral fractures.[1] Some professional guidelines recommend prophylactic calcium and vitamin D supplementation in patients who take the equivalent of more than 30 mg hydrocortisone (7.5 mg of prednisolone), especially when this is in excess of three months.[2][3] The use of thiazide diuretics, and gonadal hormone replacement has also been recommended, with the use of calcitonin, bisphosphonates, sodium fluoride or anabolic steroids also suggested in refractory cases.[4] Alternate day use may not prevent this complication.[5]
Mechanism
Mechanisms of SIOP include:[6]
Direct inhibition of osteoblast function
Direct enhancement of bone resorption
Inhibition of gastrointestinal calcium absorption
Increased urine calcium loss
Inhibition of sex steroids
Diagnosis
The diagnosis of osteoporosis can be made using conventional radiography and by measuring the bone mineral density (BMD). The most popular method of measuring BMD is Dual-energy X-ray absorptiometry.
In addition to the detection of abnormal BMD, the diagnosis of osteoporosis requires investigations into potentially modifiable underlying causes; this may be done with blood tests. Depending on the likelihood of an underlying problem, investigations for cancer with metastasis to the bone, multiple myeloma, Cushing's disease and other above-mentioned causes may be performed.
References
^Allen CS, Yeung JH, Vandermeer B, Homik J (October 2016). "Bisphosphonates for steroid-induced osteoporosis". The Cochrane Database of Systematic Reviews. 10: CD001347. doi:10.1002/14651858.CD001347.pub2. PMID 27706804.
^Bone and Tooth Society of Great Britain, National Osteoporosis Society, Royal College of Physicians (2003). Glucocorticoid-induced Osteoporosis(PDF). London, UK: Royal College of Physicians of London. ISBN 978-1-86016-173-5.CS1 maint: Multiple names: authors list (link)
^Homik J, Suarez-Almazor ME, Shea B, Cranney A, Wells G, Tugwell P (2000). "Calcium and vitamin D for corticosteroid-induced osteoporosis". The Cochrane Database of Systematic Reviews (2): CD000952. doi:10.1002/14651858.CD000952. PMID 10796394.
^Lukert BP, Raisz LG (March 1990). "Glucocorticoid-induced osteoporosis: pathogenesis and management". Annals of Internal Medicine. 112 (5): 352–64. doi:10.7326/0003-4819-112-5-352. PMID 2407167.
^Gourlay M, Franceschini N, Sheyn Y (February 2007). "Prevention and treatment strategies for glucocorticoid-induced osteoporotic fractures". Clinical Rheumatology. 26 (2): 144–53. doi:10.1007/s10067-006-0315-1. PMID 16670825.
^Steroid-induced osteoporosis By Susan Ott, MD. Updated January 28, 2009. Retrieved on 26 March 2009
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Diseases of the endocrine system (E00–E35, 240–259)
…prevention and treatment of glucocorticoid-induced osteoporosis included some premenopausal women. In premenopausal women included in clinical trials for glucocorticoid-induced osteoporosis, fractures were generally …
…clinical features, and evaluation of glucocorticoid-induced osteoporosis will be reviewed here. The prevention and treatment of glucocorticoid-induced osteoporosis are presented separately. The deleterious …
…vitamin D intake should be encouraged. Guidance for the prevention and treatment of glucocorticoid-induced osteoporosis is discussed in detail separately. Patients should be routinely asked about adverse…
…premenopausal women with glucocorticoid-induced osteoporosis . In a secondary analysis of a randomized trial of teriparatide versus alendronate in patients with glucocorticoid-induced osteoporosis, the increase in …
…American College of Rheumatology (ACR): Guideline for the prevention and treatment of glucocorticoid-induced osteoporosis (2017) American Academy of Pediatrics (AAP): Clinical report on bone densitometry…
Clodronate in the management of different musculoskeletal conditions.
Frediani B, Giusti A, Bianchi G, Dalle Carbonare L, Malavolta N, Cantarini L, Saviola G, Molfetta L.
Minerva medica. 2018 Aug;109(4)300-325.
Clodronic acid is a non-nitrogen-containing bisphosphonate largely used from some decades in the prevention and treatment of postmenopausal and secondary osteoporosis. In addition to antiresorptive activity, clodronate has shown anti-inflammatory and analgesic properties, and modulatory effects on b
… The effect of inhaled corticosteroid (ICS) on the bone status of asthmatic patients is still uncartain, becuase it can differ by race and because there have been few cases in Japan. … It may be necessary to manage and treat female patients for potent corticosteroid-inducedosteoporosis, although further analyses of bone status in asthma patient ICS users will be required.<br> …
Glucocorticoid-induced osteoporosis (GIO) is a serious consequence of glucocorticoid therapy leading to fractures in 30—50% of patients. A wide range of protective medications have been studied in this condition ...
Glucocorticoid-induced osteoporosis is a form of osteoporosis that is caused by taking glucocorticoid medicines. These drugs include prednisone (Deltasone, Orasone, etc.), prednisolone (Prelone), dexamethasone (Decadron ...
Corticosteroid-Induced Osteoporosis is treated at Cedars-Sinai Medical Center. Corticosteroid-Induced Osteoporosis is treated at Cedars-Sinai Medical Center. ...