GLUCOCORTICOID-INDUCED OSTEOPOROSIS - PATHOGENESIS, PREVENTION AND TREATMENT, WITH SPECIAL REGARD TO THE RHEUMATIC DISEASES

Objectives. To review factors associated with development of osteoporo sis in patients with rheumatic diseases, as well as the preventive and therapeutic measures. Design. A MEDLINE literature search. Results. 1 Pathogenesis. Rheumatoid arthritis in itself causes reduction of bone mass; this process can be aggravated by glucocorticoid treatment. Wit h glucocorticoid treatment, bone mineral density decrease is most pron ounced during the first months of treatment. There is no agreement on the effects of daily dose, cumulative dose, and duration of glucocorti coid treatment on the rate of bone loss. However, with treatment by lo w doses (< 10 mg of prednisone equivalent per day), bone loss appears to be minimal or even undetectable compared to controls. Alternate day treatment, or treatment with steroid 'pulses' have not been shown to protect from bone loss. 2 Prevention and treatment. Prophylactic and t herapeutic measures for glucocorticoid-induced osteoporosis include ca lcium supplementation, vitamin D in physiological doses and oestrogen in perimenopausal female patients. Efficacy has not always been shown in this particular indication but is extrapolated from other forms of osteoporosis. Limited data exist on treatment with anabolic steroids, calcitonin (with an additional analgesic effect) and biphosphonates an d reduction of fracture rates has not yet been investigated. At presen t, there is insufficient evidence to show that altered steroid molecul es can dissociate adverse effects on bone from clinically desirable ef fects. Conclusion. In view of the paucity of study data, prophylaxis a nd therapy of glucocorticoid-induced osteoporosis should receive more attention in future clinical studies.