Prevention and treatment of glucocorticoid-induced osteoporosis

Glucocorticoids are critical to the successful management of chronic noninfectious inflammatory diseases, including asthma, chronic lung diseases, inflammatory bowel disease, rheumatoid arthritis, other connective tissue diseases, and organ transplantation. Bone loss is the most devastating adverse effect of these powerful medications. Calcium and vitamin D supplementation, thiazide diuretics, and antiresorptive agents, such as gonadal hormone replacement, calcitonin, and bisphosphonates are available to prevent and reverse glucocorticoid-induced bone loss. Because glucocorticoids can cause hypogonadism, gonadal hormone replacement is essential. Lf gonadal hormone replacement is contraindicated, calcitonin or bisphosphonates are recommended. These agents may have additive effects in preventing bone loss when used in combination. More recently, studies evaluating parathyroid hormone fragments have shown promising results. This article reviews the literature and recommends strategies for the prevention and treatment of glucocorticoid-induced osteoporosis.