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January 2006

Glucocorticoid-Induced Bone Loss in Dermatologic Patients: An Update

Author Affiliations

Author Affiliations: Departments of Dermatology, Drexel University College of Medicine, Philadelphia, Pa (Dr Summey), and Wake Forest University School of Medicine, Winston-Salem, NC (Dr Yosipovitch).

Arch Dermatol. 2006;142(1):82-90. doi:10.1001/archderm.142.1.82

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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