Treatment and Prevention of Glucocorticoid-Induced Osteoporosis

Abstract

Glucocorticoids increase bone resorption and inhibit bone formation, increasing the risk of osteoporosis and fragility fracture. Early, rapid decline in bone mineral density occurs within the first 3 6 months of glucocorticoid therapy, even at low doses. Therefore, risk assessment, counseling, and preventative measures should be implemented early, at the outset of therapy. Such strategies include the use of the lowest effective glucocorticoid dose; certain lifestyle modifications, such as weight-bearing exercise and fall prevention; and calcium and vitamin D supplementation in all patients. A dual-energy x-ray absorptiometry (DXA) scan should be performed to evaluate bone mineral density. Those with osteoporosis (T-score < a = 2.5) and osteopenia (T-score between a = 2.5 and a = 1.0) are at increased risk of fragility fracture and may be candidates for pharmacologic therapy depending on individual factors such as age, sex, and Fracture Risk Assessment Tool (FRAX) risk calculation. Options for therapy include bisphosphonates, which have demonstrated safety and efficacy and are first-line agents for fracture prevention. Close monitoring of bone mineral density with annual DXA scan of the lumbar spine and hip is warranted while taking glucocorticoids to evaluate for bone demineralization and response to therapy.