Glucocorticoid-induced osteoporosis: An update on effects and management - 30/10/13

Doi : 10.1016/j.jaci.2013.08.040

Bjoern Buehring, MD ^a,^b,^⁎^{^{∗
These authors contributed equally to this manuscript and are joint first authors.}} , Ravi Viswanathan, MD ^c,^⁎^{^{∗
These authors contributed equally to this manuscript and are joint first authors.}} , Neil Binkley, MD ^a,^b, William Busse, MD ^c
^a University of Wisconsin Osteoporosis Research Program, Division of Geriatrics and Gerontology, University of Wisconsin School of Medicine & Public Health, Madison, Wis
^b GRECC, William S. Middleton Memorial Veterans Hospital, Madison, Wis
^c Department of Medicine, Section of Allergy, Pulmonary & Critical Care, University of Wisconsin School of Medicine & Public Health, Madison, Wis

^∗Corresponding author: Bjoern Buehring, MD, University of Wisconsin Osteoporosis Research Program, Section of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine & Public Health, 2870 University Ave, Suite 100, Madison, WI 53705.^∗Ravi Viswanathan, MD, Division of Allergy, Pulmonary & Critical Care, Department of Medicine, University of Wisconsin School of Medicine & Public Health, H4/612 CSC, 600 Highland Ave, Madison, WI 53792.

Abstract

Glucocorticoids remain a cornerstone of guideline-based management of persistent asthma and allergic diseases. Glucocorticoid-induced osteoporosis (GIO) is the most common iatrogenic cause of secondary osteoporosis and an issue of concern for physicians treating patients with inhaled or oral glucocorticoids either continuously or intermittently. Patients with GIO experience fragility fractures at better dual-energy x-ray absorptiometry T-scores than those with postmenopausal or age-related osteoporosis. This might be explained, at least in part, by the effects of glucocorticoids not only on osteoclasts but also on osteoblasts and osteocytes. Effective options to detect and manage GIO exist, and a management algorithm has been published by the American College of Rheumatology to provide treatment guidance for clinicians. This review will summarize GIO epidemiology and pathophysiology and assess the role of inhaled and oral glucocorticoids in asthmatic adults and children, with particular emphasis on the effect of such therapies on bone health. Lastly, we will review the American College of Rheumatology GIO guidelines and discuss diagnostic and therapeutic strategies to mitigate the risk of GIO and fragility fractures.

Le texte complet de cet article est disponible en PDF.

Key words : Glucocorticoid, inhaled and oral corticosteroid, asthma, growth, osteoporosis, bisphosphonates

Abbreviations used : ACR, AFF, ASBMR, BDP, BMD, CAMP, DXA, FDA, GIO, ICS, LABA, OCS, OR