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Management of bone disease in patients on long term glucocorticoid therapy
  1. Department of Medicine
  2. Addenbrooke’s Hospital
  3. Hills Road
  4. Cambridge CB2 2QQ, UK

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Osteoporosis is a well documented complication of gastrointestinal disease. Its pathogenesis is multifactorial but glucocorticoid therapy is likely be an important contributory factor, particularly in patients with inflammatory bowel disease.1A widely recognised condition, glucocorticoid induced osteoporosis is under diagnosed and often inadequately treated. Two recent surveys, one from a large teaching hospital2 and one community based,3 reported that only a small minority of patients receiving long term glucocorticoid therapy were offered prophylaxis against bone loss. However, recent evidence shows that intervention can prevent bone loss and reduce the significant morbidity associated with glucocorticoid induced osteoporosis.4 ,5 This emphasises the need to adopt a more aggressive approach towards prevention of osteoporosis, and to define management strategies for patients who are treated with glucocorticoids.

Characteristics of glucocorticoid induced bone loss

The time course of glucocorticoid induced bone loss has not been well documented but there is evidence that the rate of loss is most rapid in the first six to 12 months of treatment and decreases thereafter.6 ,7 If these findings are confirmed, there are clear implications for the timing of intervention. Although not all studies are in agreement, most data indicate that the spine and proximal femur are affected similarly8 and observational studies suggest that the risk both of hip and vertebral fractures is higher in patients treated with glucocorticoids.9 ,10 Data from placebo controlled primary prevention trials indicate rates of bone loss in untreated patients in the region of 2–4% each year, both in the spine and proximal femur.4 ,11 This is considerably in excess of rates of bone loss expected in a healthy population of similar age and sex distribution.

Attempts to show a correlation between the dose and duration of glucocorticoid therapy, and bone loss, have produced conflicting results. This may …

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