Recommendations for the registration of agents for prevention and treatment of glucocorticoid-induced osteoporosis: an update from the Group for the Respect of Ethics and Excellence in Science

Excerpt

Oral glucocorticoid therapy is widely used for the treatment of a variety of diseases. Approximately 1% of the population is prescribed oral glucocorticoids, and in the elderly this prevalence rises to 2.5% [1]. The association between glucocorticoid therapy and osteoporosis is well documented and exhibits some characteristic features [2]. Bone loss is particularly rapid in the first few months after initiation of therapy, with a slower rate of loss subsequently [3]. Fracture risk also increases rapidly during the early months of therapy and declines after its cessation [4, 5]. Both cortical and cancellous bone are affected, and there is some reversibility of bone loss after cessation or reduction of therapy [3, 6]. Although the severity of osteoporosis is related to the dose and duration of glucocorticoid therapy, some increase in fracture risk is seen even at daily doses of ≤7.5 mg daily for 3–6 months [4, 5]. Finally, the effect of glucocorticoids on bone fragility is, to some extent, independent of bone mineral density, fractures occurring at a higher bone mineral density (BMD) threshold than in postmenopausal osteoporosis (PMO) [7‐9]. …