Journal
CURRENT OSTEOPOROSIS REPORTS
Volume 11, Issue 4, Pages 341-347Publisher
SPRINGER
DOI: 10.1007/s11914-013-0173-0
Keywords
Osteoporosis; Glucocorticoid; Treatment; Teriparatide; Bisphosphonates; Calcium; Vitamin D; Rheumatoid arthritis; Lupus; Ankylosing spondylitis
Categories
Funding
- Advisory Board for Amylin/BMS
- Janssen
- Amgen
- Eli Lilly
- Merck
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Rheumatologic diseases are associated with a proinflammatory state, which is thought to lead to many of the bone changes seen in treatment-naive patients. However, glucocorticoids remain a common treatment option for rheumatologic diseases and are known to have a negative impact on bone through direct effects on bone cells and indirect effects on calcium absorption. Despite the anti-inflammatory effect of glucocorticoids, fracture risk rises within the first 3 months of treatment. As such, osteoporosis prevention and treatment needs to be considered in all patients started on chronic glucocorticoids (>= 3 months of treatment). For very low risk patients, conservative management with non-pharmacologic strategies may be appropriate. For the moderate to high fracture risk patients treated with glucocorticoids, pharmacologic treatment with 1 of the 4 approved medications should be considered. The challenge of educating physicians and patients of the risks of glucocorticoid induced osteoporosis remain.
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