In the review by Yosipovitch et al titled "Suggested Rationale for Prevention and Treatment of Glucocorticoid-Induced Bone Loss in Dermatologic Patients," published in the April issue of the ARCHIVES (2001;137:477-481), some errors occurred on pages 477 and 479-481.
On page 477, the first paragraph of the introduction of the main text beginning with "We recommend that patients who are receiving a long-term regimen of corticosteroids be managed with a 3-pronged approach. . . . " should have been the last paragraph of the abstract. The author listed in the byline as Goh Chee Leok, MD, should have read Chee Leok Goh, MD, and the authors' affiliations should have read, "From the National Skin Center, Singapore (Drs Yosipovitch, Hoon, and Goh)."
On page 479, in the last sentence of the first paragraph, "hyperkalemic" should have been spelled "hypercalcemic."
On pages 480 and 481, the guidelines in the "Conclusions" section should have read as follows:
Risk Assessment:
Baseline lumbar spine and femoral neck bone mineral density assessment (DXA testing) at the beginning of therapy and twice annually thereafter.
In patients 60 years of age or older, a yearly radiography assessment of the spine to exclude fractures.
Prevention:
Weight-bearing and non–weight-bearing exercises and physical therapy.
Refraining from smoking and excessive alcohol consumption.
Administration of 800 IU/d of vitamin D, plus 1000 mg/d of calcium, on commencing high-dose, long-term glucocorticoid treatment, excluding those with hypercalcemia, hypercalciuria, and/or nephrolithiasis.
Women with early and late menopause receiving high-dose, long-term glucocorticosteroid treatment should be given 0.625-1.25 mg/d of conjugated estrogen or 50 µg/d of transdermal estradiol, alone or with progestogen preparations.
Patients who have osteopenia defined as T scores below −1 at the beginning of systemic glucocorticoid treatment and patients with accelerated bone loss during the first 6 to 12 months of treatment may be considered for treatment with a bisphosphonate (eg, 5 mg/d of alendronate, 5 mg/d of risedronate, or 400 mg/d of cyclical etidronate).
Treatment:
In patients with bone densities more than 2.5 SDs below the young normal mean (T score less than −2.5) or in those patients with previous osteoporotic fractures or significant osteoporosis on radiography, the addition of a bisphosphonate should include 10 mg/d of alendronate (approved by the Food and Drug Administration for patients receiving prolonged glucocorticoid therapy), 5 mg/d of risedronate, or 400 mg/d of cyclical etidronate. Patients with severe osteoporosis, especially those with symptoms and fractures, may add 200 IU/d of nasal calcitonin to their regimen.
Postmenopausal women with low bone density should be given 60 mg/d of raloxifene hydrochloride.
Follow-up:
Yearly assessment of serum blood and urine calcium excretion and alkaline phosphatase levels.
Referral to a rheumatologist or endocrinologist specializing in the treatment of osteoporosis for assessment and long-term management.