Immunosuppressive therapy osteoporosis with

Clinicians must follow patient responses to immunosuppressant therapy, including identifying and treating the adverse sequelae associated with lifelong immunosuppression, such as cardiovascular disease, malignancy, infection, and osteoporosis, among others. 

The immunosuppressive effect of cytotoxic agents, with or without the concurrent use of steroids, can result in serious infections, which are the primary cause of death in patients with minimal-change nephropathy. Other toxicities associated with cyclophosphamide include gonadal fibrosis, which results in sterility, hemorrhagic cystitis, alopecia, and a potential to develop malignancy in those on long-term treatment. Patients on chronic steroid therapy often develop growth retardation, osteoporosis, obesity, and cataracts. ... 

Alendronate is currently the drug of choice to prevent osteoporosis in patients who must be maintained on steroids for their antiinflammatory and immunosuppressive effects. The drug also decreases bone resorption during menopause and is sometimes favored in patients who are at risk for neoplasias if treated with sex hormones. Care must be taken with alendronate to avoid esophageal ulceration. Estrogen hormone replacement therapy +/- vitamin D also has proven value for slowing bone resorption in menopause, and increases in bone mass have been reported for combinations of estrogens with alendronate. 

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