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HERO ID
7363704
Reference Type
Journal Article
Subtype
Review
Title
Glucocorticoid-induced osteoporosis: 2019 concise clinical review
Author(s)
Adami, G; Saag, KG
Year
2019
Is Peer Reviewed?
1
Journal
Osteoporosis International
ISSN:
0937-941X
EISSN:
1433-2965
Volume
30
Issue
6
Page Numbers
1145-1156
Language
English
PMID
30805679
DOI
10.1007/s00198-019-04906-x
Abstract
Glucocorticoids remain widely used for many medical conditions, and fractures are the most serious common adverse event related to long-term glucocorticoid use. Glucocorticoid-induced osteoporosis (GIOP) develops in a time- and dose-dependent manner, but even at low doses, an increased risk of fragility fracture may be observed even within the first month of treatment. GIOP is mediated by multiple pathophysiologic mechanisms resulting in an inhibition of bone formation and an increase in bone resorption. The clinical assessment of GIOP has potential pitfalls since dual-energy X-ray absorptiometry (DXA) may underestimate the risk of fracture in patients treated with glucocorticoids. Many national organizations have developed guidelines for assessing fracture risk and treating patients with, or at risk for, GIOP. These groups advocate both antiresorptive agents and bone-forming agents based predominately on their efficacy in improving bone mineral density. Oral bisphosphonates are generally the first-line therapy for GIOP in most patients due to their proven efficacy, good safety, and low cost. For those patients at greater risk of fracture, teriparatide should be considered earlier, based on its ability to significantly reduce vertebral fractures when compared with alendronate. GIOP remains a major public health concern that is at least partially preventable with current and potential future therapeutic options.
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