Chronic glucocorticoid therapy-induced osteoporosis in patients with obstructive lung disease

Long-term glucocorticoid (GC) therapy has been instrumental in decreasing m orbidity and mortality in a variety of chronic inflammatory diseases, inclu ding persistent asthma, Long-term GC therapy is also widely prescribed for COPD, One of the important and often unrecognized side effects of chronic G C therapy is secondary osteoporosis, The risk of GC-induced bone loss is ro ughly correlated with daily desk, duration, and total cumulative lifetime d ose of GC treatment. Oral prednisone increases the risk of bone loss and fr acture. High doses of inhaled GCs may also increase the risk of osteopenia/ osteoporosis, but the risk appears to be less than that associated with ora l GCs, Hormone replacement therapy, oral and parenteral bisphosphonates, su pplemental calcium and vitamin D, calcitonin, and fluoride compounds have b een used, experimentally, in the management of GC-induced bone loss. Asthma and GOLD specialists are key prescribers of oral and inhaled steroids and are likely to encounter patients with significant bone loss. Despite known risk factors and the availability of reliable diagnostic tools to recognize bone loss, the opportunity to slow, reverse, and treat bone loss is often missed, We present a review of the current literature regarding the inciden ce, treatment, and prevention of osteopenia/osteoporosis secondary to chron ic GC therapy in adult asthma and COPD patients. Guidelines are presented r egarding the identification of patients at risk for developing GC-induced s econdary bone loss, and therapeutic alternatives are discussed.