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Glucocorticoid-Induced Bone Loss in Dermatologic Patients An Update

Brett T. Summey, MD; Gil Yosipovitch, MD
Arch Dermatol. 2006;142(1):82-90. doi:10.1001/archderm.142.1.82.
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Objective  To raise awareness of the new treatment options and current recommendations among dermatologists treating patients with systemic corticosteroids.

Data Sources  MEDLINE peer-reviewed publications.

Study Selection  English language and clinical pertinence to corticosteroid-induced osteoporosis.

Data Extraction  Pertinent information on pathophysiologic, epidemiologic, clinical trial, cost-effectiveness, and treatment option data regarding corticosteroid-induced osteoporosis.

Data Synthesis  Comprehensive summary of published data on the pathophysiologic, epidemiologic, clinical, and treatment data and current practice guidelines regarding corticosteroid-induced osteoporosis; creation of an algorithmic management approach for patients treated with long-term oral corticosteroids.

Conclusions  Glucocorticoid-induced bone loss is the most predictable and debilitating complication of prolonged administration of systemic corticosteroids. Every dermatologist prescribing systemic corticosteroids must be aware of corticosteroid-induced osteoporosis and ensure that every patient is receiving general measures to prevent it. Despite efficacious preventive and therapeutic options, actual implementation of these strategies remains unacceptably low. Based on currently available evidence, the first choice for prevention and treatment of glucocorticoid-induced osteoporosis should be a potent oral bisphosphonate such as alendronate (70 mg/wk) or risedronate sodium (35 mg/wk). For patients with severe osteoporosis or patients with active osteoporotic fractures, the anabolic agent teriparatide (recombinant fragmented parathyroid hormone) should be considered as a first-line option for up to 2 years.

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Figure 1.

Causes of glucocorticoid-induced bone loss. RANKL indicates receptor activator of nuclear factor κB ligand

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Figure 2.

Algorithm for prevention and treatment of bone loss. Teriparatide should be considered a first-line treatment for severe osteoporosis and patients with preexisting osteoporotic fractures. IV indicates intravenous. The asterisk indicates that dual-energy x-ray absorptiometry (DEXA) is not required to start treatment, although it is helpful in monitoring the degree of bone loss on a 6- to 12-month basis.

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