GLUCOCORTICOID-INDUCED OSTEOPOROSIS - PATHOGENESIS, PREVENTION AND TREATMENT

Glucocorticoids (GC) are widely used for anti-inflammatory and immunos supressive therapy. Thirty to 50% of GC-treated patients develop osteo porosis. Potential mechanisms of GC-induced osteoporosis (GC-OP) inclu de abnormalities in calcium balance, vitamin D metabolism, parathyroid hormone release and activity, prostaglandin E(2) and cytokine synthes is, interference with c-fos and p-53 expression in osteoblasts, and hy pogonadism. Early diagnosis and detection of patients at risk are acco mplished with rapid safe and non-invasive bone density measurements. P reventive measures include maintaining a positive calcium balance, vit amin D supplementation (if indicated) and treatment of hypogonadism. T he shortest duration and the smallest doses possible of GC for a parti cular condition are advisable. For high-risk patients and those with e stablished GC-OP calcitonin or bisphosphonate therapy is recommended.