Medicus, Vol. 31 No. 2 Osteoporoza, 2022.
Review article
Osteoporosis Caused by Glucocorticoids
Srđan Novak
Filip Mirić
Abstract
Glucocorticoids are still seen as essential drugs in many autoimmune and inflammatory diseases, and glucocorticoid-induced osteoporosis (GIOP) is still the most common form of secondary osteoporosis. Within three months of using glucocorticoids, there is an increase in bone resorption and risk of fractures, mainly vertebral but also non-vertebral. It is necessary to constantly raise awareness about GIOP, and determining bone mineral density is recommended before starting glucocorticoid therapy. In postmenopausal women and men over 50 who are exposed to oral glucocorticoids for ≥ 3 months, it is necessary to determine facture risk using the FRAX questionnaire. Treatment uses same diagnostic criteria as for postmenopausal women (T ≤ −2.5), albeit a higher threshold is suggested (T ≤ −1.5), given that bone loss may be 10% or more during the first year of glucocorticoid use. Calcium and vitamin D are usually not sufficient for the prevention of osteoporotic fractures. The drugs of first choice are mainly bisphosphonates (alendronate, risedronate), while in some cases, especially in patients who have already suffered a fracture, teriparatide is considered due to its anabolic effect and proven reduction in the number of vertebral fractures. Denosumab can also be used as a third-line treatment.
Keywords
glucocorticoids; osteoporosis; bisphosphonates; teriparatide; denosumab; FRAX
Hrčak ID:
291563
URI
Publication date:
17.1.2023.
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