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Therapies for Preventing Bone Loss with Glucocorticoid Treatment

  • Therapeutics and Medical Management (S Jan De Beur and B Clarke, Section Editors)
  • Published:
Current Osteoporosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

We aim to critically review recent recommendations regarding preventative strategies for glucocorticoid-induced osteoporosis and provide a summary of key evidence regarding available interventions.

Recent Findings

Lifestyle optimization remains the hallmark of bone health preservation. Early initiation of anti-osteoporotic agents in the setting of glucocorticoid exposure is essential, guided by appropriate risk stratification. Recommendations for calcium and vitamin D intake optimization are well-supported across all risk strata. Bisphosphonates are the mainstay of pharmacological therapy. Newer agents such as denosumab and teriparatide have demonstrated comparative benefit in terms of incident fracture risk reduction and bone mineral density preservation, with comparable adverse events. With due consideration to cost, resource availability, and patient values and preferences, these agents may warrant use as the first-line agents in this setting.

Summary

Glucocorticoid-induced osteoporosis remains preventable and warrants early and targeted evidence-based therapy.

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Authors and Affiliations

  1. Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Arnav Agarwal

  2. Department of Medicine, McMaster University, Hamilton, Ontario, Canada

    Jonathan D. Adachi

  3. Division of Rheumatology, Department of Medicine, McMaster University, 501-25 Charlton Ave E, Hamilton, ON, L8N 1Y2, Canada

    Jonathan D. Adachi

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  1. Arnav Agarwal
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Correspondence to Jonathan D. Adachi.

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Conflict of Interest

Dr. Adachi is a consultant to Amgen. He is a clinical trial investigator for Amgen and Radius. He is a speaker of Amgen and Merck. He is the past president of Osteoporosis Canada, and a member of the Board of Directors for the International Osteoporosis Foundation. Dr. Agarwal does not have any conflicts of interest to declare.

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Agarwal, A., Adachi, J.D. Therapies for Preventing Bone Loss with Glucocorticoid Treatment. Curr Osteoporos Rep 19, 34–39 (2021). https://doi.org/10.1007/s11914-020-00653-9

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