CHICAGO – Glucocorticoid-induced osteoporosis and associated fractures are not uncommon, but avoidable, according to a speaker here at the at the American College of Rheumatology State of the Art Clinical Symposium.
G. Saag, MD, MSc,
said testing with dual-energy X-ray absorptiometry (DXA) scanning can be an important monitoring tool, but getting insurance reimbursement for regular testing, such as every 6 months for patients who chronically take glucocorticoids, can be difficult.
Saag said alendronate can be a useful medication in premenopausal women who receive 7.5 mg per day of prednisone equivalent to increase BMD and prevent fractures. Other treatments, such as teriparinide (Forteo, Eli Lilly) or risedronate (Actonel, Actavis; Atelvia, Allergan) also may provide protection against fractures in at-risk patients who chronically take glucocorticoids, such as women of child-bearing age who have rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE).
Some women who chronically received glucocorticoids and bisphosphonates or other treatments for osteoporosis prevention had children with low birth weight, but Saag said disease activity from RA or SLE also may be confounding factors.
About 20% of patients with SLE diagnosed at a young age, mostly women, will have a fracture over a 15-year period after diagnosis, according to Saag, who added that data is sparse and more study is required to understand the risks and benefits of treatments.
An open-label study from Korea showed lower total hip arthroplasty prevalence among patients who received alendronate and fewer instances of osteonecrosis, Saag said, but added more study is needed to determine the risks of osteoporosis among women and men who chronically receive glucocorticoids. – by Shirley Pulawski
Saag K. Glucocorticoid-induced osteoporosis. Presented at American College of Rheumatology State of the Art Clinical Symposium; Chicago, April 9-10, 2016.
Disclosure: Relevant financial disclosures was unavailable at the time of publication.