Skip to main content
SpringerLink
Log in

Prevention and treatment of glucocorticoid-induced osteoporosis

  • Therapeutics
  • Published:
Current Osteoporosis Reports Aims and scope Submit manuscript

Abstract

Glucocorticoids continue to be used for many inflammatory diseases, and glucocorticoid-induced osteoporosis (GIOP) remains the most common secondary form of metabolic bone disease. Recent meta-analyses suggest that both active and native vitamin D can help maintain lumbar spine bone mineral density (BMD), particularly in patients receiving lower-dose glucocorticoid therapy. Recent randomized, controlled clinical trials have shown that oral bisphosphonates are superior to vitamin D in maintaining BMD and should be continued for as long as a person receives glucocorticoid treatment. Similar to the oral bisphosphonates, intravenous ibandronate has been shown to preserve BMD and also to significantly reduce vertebral fracture risk. Increasing evidence supports a role for parathyroid hormone to prevent or treat GIOP as well. Despite effective therapies, many at-risk patients fail to receive treatment for GIOP, and even among those who initiate treatment, half discontinue within 1 to 2 years. New approaches to evidence implementation are being tested to improve the quality of osteoporosis care and decrease fracture risk among long-term glucocorticoid users.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Kirwan JR, Arthritis and Rheumatism Council Low Dose glucocorticoid Study Group:The effect of glucocorticoids on joint destruction in rheumatoid arthritis.N Engl J Med 1995,333:142–146.

    Article  PubMed  CAS  Google Scholar 

  2. van Everdingen AA, Jacobs JWG, van Reesema DR, Bijlsma JWJ:Low dose prednisone therapy for patients with early active rheumatoid arthritis: clinical efficacy, disease modifying properties and side effects. A double-blind placebo-controlled clinical trial.Ann Intern Med 2002,136:1–12.

    PubMed  Google Scholar 

  3. Bijlsma JW, Hoes JN, van Everdingen AA, et al.:Are glucocorticoids DMARDs? Ann N Y Acad Sci 2006,1069:268–274.

    Article  PubMed  CAS  Google Scholar 

  4. Saag KG, Koehnke R, Caldwell JR, et al.:Low dose long-term corticosteroid therapy in rheumatoid arthritis: an analysis of serious adverse events.Am J Med 1994,96:115–123.

    Article  PubMed  CAS  Google Scholar 

  5. Curtis JR, Westfall AO, Allison J, et al.:Population-based assessment of adverse events associated with long-term glucocorticoid use.Arthritis Rheum 2006,55:420–426.

    Article  PubMed  Google Scholar 

  6. Of major importance de Nijs RN, Jacobs JW, Lems WF, et al.:Alendronate or alfacalcidol in glucocorticoid-induced osteoporosis.N Engl J Med 2006,355:675–684. Randomized controlled trial comparing alendronate versus activated vitamin D among low-dose glucocorticoid users.

    Article  PubMed  Google Scholar 

  7. van Staa TP, Geusens P, Bijlsma JW, et al.:Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis.Arthritis Rheum 2006,54:3104–3112.

    Article  PubMed  Google Scholar 

  8. van Staa T, Leufkens H, Abenhaim L, et al.:Use of oral corticosteroids and risk of fractures.J Bone Miner Res 2000,15:993–1000.

    Article  PubMed  Google Scholar 

  9. Da Silva JA, Jacobs JW, Kirwan JR, et al.:Safety of low dose glucocorticoid treatment in rheumatoid arthritis: published evidence and prospective trial data.Ann Rheum Dis 2006,65:285–293.

    Article  PubMed  CAS  Google Scholar 

  10. Adachi JD, Olszynski WP, Hanley DA, et al.:Management of corticosteroid-induced osteoporosis [review].Semin Arthritis Rheum 2000,29:228–251.

    Article  PubMed  CAS  Google Scholar 

  11. Adler R, Hochberg MC:Suggested guidelines for evaluation and treatment of glucocorticoid-induced osteoporosis for the Department of Veterans Affairs.Arch Intern Med 2003,163:2619–2624.

    Article  PubMed  Google Scholar 

  12. American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis.Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis.Arthritis Rheum 2001,44:1496–1503.

    Article  Google Scholar 

  13. Bone and Tooth Society of Great Britain:Glucocorticoid-Induced Osteoporosis: Guidelines for Prevention and Treatment. London: Royal College of Physicians of London; 2002.

    Google Scholar 

  14. Geusens P, 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.

    Article  PubMed  CAS  Google Scholar 

  15. Of importance Devogelaer JP, Goemaere S, Boonen S, et al.:Evidence-based guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis: a consensus document of the Belgian Bone Club.Osteoporos Int 2006,17:8–19. Comprehensive evidence synthesis and updated recommendations regarding GIOP management.

    Article  PubMed  CAS  Google Scholar 

  16. Nawata H, Soen S, Takayanagi R, et al.:Guidelines on the management and treatment of glucocorticoid-induced osteoporosis of the Japanese Society for Bone and Mineral Research (2004),J Bone Miner Metab 2005,23:105–109.

    Article  PubMed  Google Scholar 

  17. Lane N, Goldring S, Stewart J, Morris S:Biochemical markers of bone turnover in glucocorticoid treated patients are altered by calcium supplementation: preliminary results from the ACTIVATE trial.Arthritis Rheum 2003,48:S498.

    Article  Google Scholar 

  18. Sambrook PN:Corticosteroid osteoporosis: practical implications of recent trials.J Bone Min Res 2000,15:1645–1649.

    Article  CAS  Google Scholar 

  19. Amin S, LaValley MP, Simms RW, Felson DT:The role of vitamin D in corticosteroid-induced osteoporosis.Arthritis Rheum 1999,42:1740–1751.

    Article  PubMed  CAS  Google Scholar 

  20. Wallach S, Cohen S, Reid DM, et al.:Effects of risedronate treatment on bone density and vertebral fracture in patients on corticosteroid therapy.Calcif Tissue Int 2000,67:277–285.

    Article  PubMed  CAS  Google Scholar 

  21. Adachi R, Saag K, Emkey R, et al.:Effects of alendronate for two years on BMD and fractures in patients receiving glucocorticoids.Arthritis Rheum 2001,44:202–211.

    Article  PubMed  CAS  Google Scholar 

  22. Saag KG, Emkey R, Schnitzer T, et al.:Alendronate for the treatment and prevention of glucocorticoid-induced osteoporosis.N Engl J Med 1998,339:292–299.

    Article  PubMed  CAS  Google Scholar 

  23. Reid DM, Hughes R, Laan RF:Efficacy and safety of daily risedronate in the treatment of corticosteroid-induced osteoporosis in men and women: a randomized trial.J Bone Min Res 2000,15:1006–1013.

    Article  CAS  Google Scholar 

  24. Sambrook P, Birmingham J, Kelly P, et al.:Prevention of corticosteroid osteoporosis. A comparison of calcium, calcitriol, and calcitonin.N Engl J Med 1993,328:1747–1752.

    Article  PubMed  CAS  Google Scholar 

  25. Dykman T, Haralson K, Gluck O, et al.:Effect of oral 1,25-dihydroxyvitamin D and calcium on glucocorticoid-induced osteopenia in patients with rheumatic diseases.Arthritis Rheum 1984,27:1336–1343.

    Article  PubMed  CAS  Google Scholar 

  26. Braun JJ, Birkenhager-Frenkel DH, Rietveld AH, et al.:Influence of 1 alpha-(OH)D3 administration on bone and bone mineral metabolism in patients on chronic glucocorticoid treatment; a double blind controlled study.Clin Endocrinol 1983,18:265–273.

    Article  Google Scholar 

  27. Reginster JY, Kuntz D, Verdickt W, et al.:Prophylactic use of alfacalcidol in corticosteroid-induced osteoporosis.Osteoporos Int 1999,9:75–81.

    Article  PubMed  CAS  Google Scholar 

  28. Bijlsma JWJ, Raymakers JA, Mosch C, et al.:Effect of oral calcium and vitamin D on glucocorticoid-induced osteopenia.Clin Exper Rheumatol 1988,6:113–119.

    CAS  Google Scholar 

  29. Richy F, Ethgen O, Bruyere O, Reginster JY:Efficacy of alphacalcidol and calcitriol in primary and corticosteroid-induced osteoporosis: a meta-analysis of their effects on bone mineral density and fracture rate.Osteoporos Int 2004,15:301–310.

    Article  PubMed  CAS  Google Scholar 

  30. Richy F, Schacht E, Bruyere O, et al.:Vitamin D analogs versus native vitamin D in preventing bone loss and osteoporosis-related fractures: a comparative meta-analysis.Calcif Tissue Int 2005,76:176–186.

    Article  PubMed  CAS  Google Scholar 

  31. Of importance de Nijs RN, Jacobs JW, Algra A, et al.:Prevention and treatment of glucocorticoid-induced osteoporosis with active vitamin D3 analogues: a review with meta-analysis of randomized controlled trials including organ transplantation studies.osteoporos Int 2004,15:589–602. Meta-analyses comparing the effects of vitamin D preparations with the effects of calcium alone, no treatment, and bisphosphonates on BMD change and the risk of fractures.

    Article  PubMed  CAS  Google Scholar 

  32. Ringe J, Coster A, Meng T, et al.:Treatment of glucocorticoid-induced osteoporosis with alfacalcidol/calcium versus vitamin D/calcium.Calcif Tissue Int 1999,65:337–340.

    Article  PubMed  CAS  Google Scholar 

  33. Ringe J, Dorst A, Faber H, et al.:Superiority of alfacalcidol over plain vitamin D in the treatment of glucocorticoid-induced osteoporosis.Rheumatology Int 2004,24:63–70.

    Article  CAS  Google Scholar 

  34. Sambrook PN, Kotowicz M, Nash P, et al.:Prevention and treatment of glucocorticoid-induced osteoporosis: a comparison of calcitriol, vitamin D plus calcium, and alendronate plus calcium.J Bone Miner Res 2003,18:919–924.

    Article  PubMed  CAS  Google Scholar 

  35. Lems WF, Lodder MC, Lips P, et al.:Positive effect of alendronate on bone mineral density and markers of bone turnover in patients with rheumatoid arthritis on chronic treatment with low-dose prednisone: a randomized, double-blind, placebocontrolled trial.Osteoporos Int 2006,17:716–723.

    Article  PubMed  CAS  Google Scholar 

  36. Cohen S, Levy RM, Keller M, et al.:Risedronate therapy prevents corticosteroid-induced bone loss: A twelve-month, multicenter, randomized, double-blind, placebo-contrlled, parallel-group study.Arthritis Rheum 1999,42:2309–2318.

    Article  PubMed  CAS  Google Scholar 

  37. Emkey R, Delmas PD, Goemaere S, et al.:Changes in bone mineral density following discontinuation or continuation of alendronate therapy in glucocorticoid-treated patients: a retrospective, observational study.Arthritis Rheum 2003,48:1102–1108.

    Article  PubMed  CAS  Google Scholar 

  38. Ringe JD, Dorst A, Faber H, et al.:Intermittent intravenous ibandronate injections reduce vertebral fracture risk in corticosteroid-induced osteoporosis: results from a long-term comparative study.Osteoporos Int 2003,14:801–807.

    Article  PubMed  CAS  Google Scholar 

  39. Ringe JD, Dorst A, Faber H, et al.:Three-monthly ibandronate bolus injection offers favourable tolerability and sustained efficacy advantage over two years in established corticosteroid-induced osteoporosis.Rheumatology (Oxford) 2003,42:743–749.

    Article  CAS  Google Scholar 

  40. Campbell IA, Douglas JG, Francis RM, et al.:Five year study of etidronate and/or calcium as prevention and treatment for osteoporosis and fractures in patients with asthma receiving long term oral and/or inhaled glucocorticoids.Thorax 2004,59:761–768.

    Article  PubMed  CAS  Google Scholar 

  41. van Staa TP, Leufkens HG, Cooper C:Use of inhaled corticosteroids and risk of fractures.J Bone Miner Res 2001,16:581–588.

    Article  PubMed  Google Scholar 

  42. Lane N, Sanchez S, Modin G, et al.:Bone mass continues to increase at the hip after parathyroid hormone treatment is discontinued in glucocorticoid induced osteoporosis: results of a randomized controlled clinical trial.J Bone Min Res 2000,15:944–951.

    Article  CAS  Google Scholar 

  43. Lane NE, Sanchez S, Modin GW, et al.:Parathyroid hormone treatment can reverse corticosteroid-induced osteoporosis. Results of a randomized controlled clinical trial.J Clin Invest 1998,102:1627–1633.

    Article  PubMed  CAS  Google Scholar 

  44. Oxlund H, Ortoft G, Thomsen JS, et al.:The anabolic effect of PTH on bone is attenuated by simultaneous glucocorticoid treatment.Bone 2006,39:244–252.

    Article  PubMed  CAS  Google Scholar 

  45. Rehman Q, Lang T, Arnaud C, et al.:Daily treatment with parathyroid hormone is associated with an increase in vertebral cross-sectional area in postmenopausal women with glucocorticoid-induced osteoporosis.Osteoporos Int 2003,14:77–81.

    Article  PubMed  CAS  Google Scholar 

  46. Shiraki M, Shiraki Y, Aoki C, Miura M:Vitamin K2 (menatetrenone) effectively prevents fractures and sustains lumbar bone mineral density in osteoporosis.J Bone Miner Res 2000,15:515–521.

    Article  PubMed  CAS  Google Scholar 

  47. Koshihara Y, Hoshi K, Okawara R, et al.:Vitamin K stimulates osteoblastogenesis and inhibits osteoclastogenesis in human bone marrow cell culture.J Endocrinol 2003,176:339–348.

    Article  PubMed  CAS  Google Scholar 

  48. Yonemura K, Kimura M, Miyaji T, Hishida A:Short-term effect of vitamin K administration on prednisolone-induced loss of bone mineral density in patients with chronic glomerulonephritis.Calcif Tissue Int 2000,66:123–128.

    Article  PubMed  CAS  Google Scholar 

  49. Sasaki N, Kusano E, Takahashi H, et al.:Vitamin K2 inhibits glucocorticoid-induced bone loss partly by preventing the reduction of osteoprotegerin (OPG).J Bone Miner Metab 2005,23:41–47.

    Article  PubMed  CAS  Google Scholar 

  50. Sasaki N, Kusano E, Ando Y, et al.:Glucocorticoid decreases circulating osteoprotegerin (OPG): possible mechanism for glucocorticoid induced osteoporosis.Nephrol Dial Transplant 2001,16:479–482.

    Article  PubMed  CAS  Google Scholar 

  51. Hofbauer LC, Gori F, Riggs BL, et al.:Stimulation of osteoprotegerin ligand and inhibition of osteoprotegerin production by glucocorticoids in human osteoblastic lineage cells: potential paracrine mechanisms of glucocorticoid-induced osteoporosis.Endocrinology 1999,140:4382–4389.

    Article  PubMed  CAS  Google Scholar 

  52. van Everdingen AA, Siewertsz van Reesema DR, Jacobs JW, Bijlsma JW:Low-dose glucocorticoids in early rheumatoid arthritis: discordant effects on bone mineral density and fractures? Clin Exp Rheumatol 2003,21:155–160.

    PubMed  Google Scholar 

  53. van Staa T, Leufkens H, Cooper C:The epidemiology of corticosteroid induced osteoporosis: a meta-analysis.Osteoporos Int 2002,13:777–787.

    Article  PubMed  Google Scholar 

  54. van Staa TP, Laan RF, Barton IP, et al.:Bone density threshold and other predictors of vertebral fracture in patients receiving oral glucocorticoid therapy.Arthritis Rheum 2003,48:3224–3229.

    Article  PubMed  CAS  Google Scholar 

  55. van Staa TP, Leufkens HGM, Abenhaim L, et al.:Oral corticosteroids and fracture risk: relationship to daily and cumulative doses.Rheumatology (Oxford) 2000,39:1383–1389.

    Article  Google Scholar 

  56. American College of Rheumatology Task Force on Osteoporosis Guidelines:Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis.Arthritis Rheum 1996,39:1791–1801.

    Article  Google Scholar 

  57. van Staa T, Eastell R, Barton IP, et al.:The value of bone turnover markers in the prediction of vertebral fracture in patients using oral glucocorticoids [abstract].J Bone Miner Res 2003,18:S66.

    Article  Google Scholar 

  58. Eastell R, Barton I, Hannon R, et al.:Relationship of early changes in bone resorption to the reduction in fracture risk with risedronate.J Bone Miner Res 2003,18:1051–1056.

    Article  PubMed  CAS  Google Scholar 

  59. Simonelli C, Killeen K, Mehle S, Swanson L:Barriers to osteoporosis identification and treatment among primary care physicians and orthopedic surgeons.Mayo Clin Proc 2002,77:334–338.

    Article  PubMed  Google Scholar 

  60. Of importance van Staa TP, Geusens P, Zhang B, et al.:Individual fracture risk and the cost-effectiveness of bisphosphonates in patients using oral glucocorticoids.Rheumatology (Oxford) 2006, Epub ahead of print. Identifies subgroups of patients using long-term glucocorticoids for whom prescription therapy for GIOP is likely to be most cost-effective.

  61. Of importance Curtis JR, Wesfall AO, Allison JJ, et al.:Channeling and adherence with alendronate and risedronate among chronic glucocorticoid users.Osteoporos Int 2006,17:1268–1274. Highlights poor long-term compliance with bisphosphonate therapy among long-term glucocorticoid users.

    Article  PubMed  CAS  Google Scholar 

  62. Walsh LJ, Wong CA, Pringle M, Tattersfield AE:Use of oral corticosteroids in the community and the prevention of secondary osteoporosis: a cross sectional study.BMJ 1996,313:344–346.

    PubMed  CAS  Google Scholar 

  63. Buckley LM, Marquez M, Feezor R, et al.:Prevention of corticosteroid-induced osteoporosis: results of a patient survey.Arthritis Rheum 1999,42:1736–1739.

    Article  PubMed  CAS  Google Scholar 

  64. Mudano A, Allison J, Hill J, et al.:Variations in glucocorticoid induced osteoporosis prevention in a managed care cohort.J Rheumatol 2001,28:1298–1305.

    PubMed  CAS  Google Scholar 

  65. Gudbjornsson B, Juliusson UI, Gudjonsson FV:Prevalence of long term steroid treatment and the frequency of decision making to prevent steroid induced osteoporosis in daily clinical practice.Ann Rheum Dis 2002,61:32–36.

    Article  PubMed  CAS  Google Scholar 

  66. Solomon DH, Katz J, Jacobs JW, et al.:Management of glucocorticoid induced osteoporosis in patients with rheumatoid arthritis.Arthritis Rheum 2002,46:3136–3142.

    Article  PubMed  Google Scholar 

  67. Ramsey-Goldman R:Missed opportunities in physician management of glucocorticoid-induced osteoporosis? Arthritis Rheum 2002,46:3115–3120.

    Article  PubMed  Google Scholar 

  68. Saag KG, Gehlbach SH, Curtis JR, et al.:Trends in prevention of glucocorticoid-induced osteoporosis.J Rheumatol 2006,33:1651–1657.

    PubMed  Google Scholar 

  69. Curtis JR, Westfall AO, Allison JJ, et al.:Longitudinal patterns in the prevention of osteoporosis in glucocorticoid-treated patients.Arthritis Rheum 2005,52:2485–2494.

    Article  PubMed  Google Scholar 

  70. Chantler IW, Davie MW, Evans SF, Rees JS:Oral corticosteroid prescribing in women over 50, use of fracture prevention therapy, and bone densitometry service.Ann Rheum Dis 2003,62:350–352.

    Article  PubMed  CAS  Google Scholar 

  71. Rosen HN, Rosenblatt M:Prevention and treatment of glucocorticoid-induced osteoporosis. InUp To Date, vol. 11, no. 1. Edited by Rose B. Wellesley, MA: UpToDate; 2003.

    Google Scholar 

  72. Buckley LM, Marquez M, Hudson JO, et al.:Variations in physician perceptions of the risk of osteoporosis in corticosteroid users by physician specialty.J Rheumatol 1998,25:2195–2202.

    PubMed  CAS  Google Scholar 

  73. Blalock SJ, Norton LL, Patel RA, Dooley MA:Patient knowledge, beliefs, and behavior concerning the prevention and treatment of glucocorticoid-induced osteoporosis.Arthritis Rheum 2005,53:732–739.

    Article  PubMed  Google Scholar 

  74. Liu RH, Albrecht J, Werth VP:Cross-sectional study of bisphosphonate use in dermatology patients receiving long-term oral corticosteroid therapy.Arch Dermatol 2006,142:37–41.

    Article  PubMed  CAS  Google Scholar 

  75. Naunton M, Peterson GM, Jones G, et al.:Multifaceted educational program increases prescribing of preventive medication for corticosteroid induced osteoporosis.J Rheumatol 2004,31:550–556.

    PubMed  Google Scholar 

  76. Solomon DH, Katz JN, La Tourette AM, Coblyn JS:Multifaceted intervention to improve rheumatologists’ management of glucocorticoid-induced osteoporosis: a randomized controlled trial.Arthritis Rheum 2004,51:383–387.

    Article  PubMed  CAS  Google Scholar 

  77. McDonough RP, Doucette WR, Kumbera P, Klepser DG:An evaluation of managing and educating patients on the risk of glucocorticoid-induced osteoporosis.Value Health 2005,8:24–31.

    Article  PubMed  Google Scholar 

  78. Kiefe CI, Allison JJ, Williams OD, et al.:Improving quality improvement using achievable benchmarks for physician feedback: a randomized controlled trial.JAMA 2001,285:2871–2879.

    Article  PubMed  CAS  Google Scholar 

  79. Curtis JR, Westfali AO, Allison JJ, et al.: Challenges in improving the quality of osteoporosis care for long term glucocorticoid users: a prospective, randomized trial.Arch Intern Med. In press.

Download references

Author information

Authors and Affiliations

  1. University of Alabama at Birmingham, FOT 840, 510 20th Street South, 35294, Birmingham, AL, USA

    Jeffrey R. Curtis

Authors
  1. Jeffrey R. Curtis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenneth G. Saag
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeffrey R. Curtis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Curtis, J.R., Saag, K.G. Prevention and treatment of glucocorticoid-induced osteoporosis. Curr Osteoporos Rep 5, 14–21 (2007). https://doi.org/10.1007/BF02938618

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02938618

Keywords

Search

Navigation