Management of glucocorticoid-induced osteoporosis: prevalence, and emerging treatment options

Figures & data

Figure 1 Effects of glucocorticoids on bone. Derived from.^20,85

Abbreviations: TST, testosterone; LH, luteinizing hormone; FSH, follicle-stimulating hormone; GI, gastrointestinal; Ca, calcium.

Table 1 Risk factors – indications for densitometry

Estrogen defficiency

Early menopause (<45 years)

Prolonged secondary amenorrhea (>1 year)

Primary hypogonadism

Glucocorticoid use (>5 mg prednisolone >3 months) is expressly the indication of densitometry

Mother history of hip fracture

Low body mass index (BMI < 19 kg/m^2)

Diseases that leads to secondary osteoporosis

Anorexia nervosa

Malabsorption

Primary hyperparathyroidism

Diffuse diseases of connective tissue

Rheumatoid arthritis

Chronic inflammatory bowel diseases

Post-transplantation syndrome

Chronic renal failure

Hyperthyroidism

Prolonged immobilization

Cushing’s syndrome

Chronic hepatopathies

Myeloproliferative diseases

Hereditary and metabolic bone diseases

Suspicion of osteoporosis from X-ray or finding vertebral deformity

Hip, vertebral or forearm fracure with low trauma

Decrease in stature or thoracic kyphosis

Monitoring antiresorptive therapy

Chronic medications (anticoagulants, antiepileptics, thyroid hormones, cytostatics)

Women over 65 years

Men over 70 years

Modified from Payer et al 2007.¹¹

Table 2 FRAX^™ Model – clinical risk factors (CRF)

Age Sex Bone mineral density Prior history of fracture Parental history of fracture Current smoking Current alcohol >3 units/day Rheumatoid arthritis Glucocorticoid use Secondary osteoporosis – Hypogonadism – Premature menopause (<45 years) – Chronic malnutrition or malabsorption – Osteogenesis imperfecta – Chronic liver disease – Type I diabetes – Long-term hyperthyroidism

Notes: Each CRF independently contributes to fracture probability; Presence of ≥1 CRF increases probability of fracture incrementally. FRAX™. http://www.shef.ac.uk/FRAX/index.htm

Figure 2 Diagnostic and therapeutic steps in making decisions for the prevention of glucocorticoid-induced osteoporosis. Reproduced from Geusens PP, de Nijs RNJ, Lems WF, et al. Prevention of glucocorticoid osteoporosis: a consensus document of the Dutch Society for Rheumatology. Ann Rheum Dis. 2004;63:324–325. Copyright © 2004, with permission from BMJ Publishing Group Ltd.

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