Osteoporosis steroid-induced

Uses Rx prevent osteoporosis male female, Rx steroid-induced osteoporosis, Paget Dz Action -1- N1 abnormal bone resorption Dose Osteoporosis Rx 10 mg/d PO or 70 mg qwk Fosamax plus D 1 tab qwk Steroid-induced osteoporosis Rx 5 mg/d PO Prevention 5 mg/d PO or 35 mg qwk Paget Dz 40 mg/d PO Caution [C, ] Not OK if CrCl <35 mLAnin, w/ NSAID use Contra Esophageal anomalies, inability to sit/stand upright for 30 min, X Ca Disp Tabs, soln SE GI disturbances, esophageal irritation, HA, pain, jaw osteonecrosis (w/ dental procedures, chemo) Interactions -1- Absorption W7 antacids, Ca supls, Fe, food T risk of upper GI bleed W/ ASA NSAIDs EMS May cause cardiac conduction abnormalities d/t T Ca T risk of jaw fractures esp w/ dental procedures OD May cause hypocalcemia and adverse upper-GI effects milk or antacids can be given to bind alendronate... 

Finally, bisphosphonates have an important place in treatment of osteoporosis of all causes, including steroid-induced osteoporosis. Disodium etidronate, alendronate and clodronate all have potent effects to restore bone mass, and this effect persists for several years of therapy. Newer drugs such as zoledronic acid can be administered by infrequent (once-yearly) infusion, which can help compliance and reduce side effects. 

Gudbjornsson B, Juliusson UI, Gudjonsson FV. Prevalence of long term steroid treatment and the frequency of decision making to prevent steroid induced osteoporosis in daily clinical practice. Ann Rheum Dis... 

In principle an anti-estrogen might precipitate osteoporosis, but tamoxifen has not been shown to do so indeed, there is reason to believe that it protects the skeleton against steroid-induced bone loss (62), and in some studies of the state of the bones during treatment with tamoxifen there was actually a higher bone density than in controls. 

Brown JJ, Zacharin MR. Proposals for prevention and management of steroid-induced osteoporosis in children and adolescents. J Paediatr Child Health. 2005 41 553-557. 

Sambrook PN. How to prevent steroid induced osteoporosis. Ann Rheum Dis. 2005 64 176-178. 

Certaiu medicatious have beeu associated with au iucrease iu osteoporosis risk, particularly steroids and anticonvulsants. Steroid-induced osteoporosis arises due to use of glucocorticoids, analogous to Cushing s syndrome, and involving mainly the axial skeleton prednisone... 

Manolagas SC, Weinstein RS. New developments in the pathogenesis and treatment of steroid-induced osteoporosis. J Bone Miner Res 1999 14 1061-1066. 

Homik J, Cranney A, Shea B, et al. Bisphosphonates for steroid induced osteoporosis. Cochrane Database Syst Rev 2000 2 CD001347. 

The drug of choice for management of adrenal steroid-induced osteoporosis is... 

In addition to the suppression of the hypophysial-pituitary axis and adrenal atrophy, these drugs can cause a variety of adverse effects, including osteoporosis, pancreatitis, steroid-induced diabetes mellitus, cataracts, glaucoma, psychosis, oral candidiasis and other opportunistic infections, immunosuppression, infertility, weight gain, and skin atrophy. Severe edema may also be produced, particularly in the face, depending on the degree of mineralocorticoid activity. 

The bisphosphonates deaease bone resorption and slow the progress of osteoporosis. Alendronate is effective for treatment of postmenopausal and steroid-induced osteoporosis. The principal potential side effects are gastrointestinal distress and esophageal ulcers. 

Unfortunately steroids merely suppress the inflammation while the underlying cause of the disease remains. Another serious concern about steroids is that of toxicity. The abmpt withdrawal of glucocorticoid steroids results in acute adrenal insufficiency. Long term use may induce osteoporosis, peptidic ulcers, the retention of fluid, or an increased susceptibiUty to infections. Because of these problems, steroids are rarely the first line of treatment for any inflammatory condition, and their use in rheumatoid arthritis begins after more conservative therapies have failed. 

Summary term for a number of steroid hormones and their precursors with differentiation-inducing activity in many tissues. As regards bone, three components are relevant cholecalciferol ( vitamin D ) 25-hydroxyvi-taminD3 (calcidiol) and 1,25-dihydroxy vitamin D3 (calcitriol). The latter is the biologically active form and increases both intestinal calcium absoiption and bone resorption. Vitamin D preparations are widely used for the treatment of osteoporosis. Daily supplementation with vitamin D reduces bone loss in postmenopausal women and hip fractures in elderly subjects. 

Arshad M, Sengupta S, Sharma S, Ghosh R, Sawlani V, Singh MM (2004) In vitro anti-resorptive activity and prevention of ovariectomy-induced osteoporosis in female Sprague-Dawley rats by ormeloxifene, a selective estrogen receptor modulator. J Steroid Biochem Mol Biol 91(l-2) 67-78... 

It can occur in the presence of particular hormonal disorders and chronic diseases, or as a result of medications, specifically glucocorticoids (steroid- or glucocorticoid-induced osteoporosis). A major risk factor for osteoporosis in both men and women is advanced age. In females, oestrogen deficiency following menopause is correlated with a rapid reduction in BMD, while in men a decrease in testosterone has a comparable (bnt less pronounced) effect. European or Asian ancestry predisposes for osteoporosis. 

However, it is not unreasonable to assume that enzyme inducers that increase the metabolism of contraceptive steroids (see Table 28.1 , (p.975)) would also increase the metabolism of oestrogens used for HRT. Some manufacturers state that these drugs may reduce the efficacy of HRT preparations. This would be most likely to be noticed where HRT is prescribed for menopausal vasomotor symptoms, but might be difficult to detect where the indication is osteoporosis. The interaction is not relevant to HRT applied locally for menopausal vaginitis. It has also been suggested that any interaction is less likely with transdermal HRT, which bypasses hepatic first-pass metabolism. Further study is needed to confirm the importance of this possible interaction. 

Reduction of bone resorption. Zhang et al. investigated this activity in more than one study. The first two studies investigated the mechanism of reduction of bone loss in animal models and found that epimedium-de-rived phytoestrogenic flavones prevented estrogen deficiency-induced osteoporosis and steroid-associated osteonecrosis in rats and rabbits, respectively. The final study, a double-blind placebo-controlled clinical trial conducted on postmenopausal women, showed that the same preparation had a beneficial effect toward reducing bone resorption after 24 months of use. ... 

As RJ contains testosterone [24] and possesses steroid hormone-type activities [54—57], it was hypothesized that it may have beneficial effects on osteoporosis. In a recent study, both an ovariectomized rat model and a tissue culture model were used. The results of the study indicated that RJ was almost as effective as 17p-estradiol in preventing the development of bone loss induced by ovariectomy in rats. In tissue culture models, RJ increased calcium contents in femoral-diaphyseal and femoral-metaphyseal tissue cultures obtained from normal male rats however, in a mouse marrow culture model, it neither inhibited the parathyroid hormone (PTH)-induced calcium loss nor affected the formation of osteoclast-like cells induced by PTH. Therefore, these results suggested that RJ may prevent osteoporosis by enhancing intestinal calcium absorption, but not by directly antagonizing the action of PTH [60]. In a comparable study, it was investigated whether RJ and bee pollen reduce the bone loss due to osteoporosis in oophorectomized female rats model. It was concluded that RJ and bee pollen after a 12-week treatment decrease the bone loss due to osteoporosis, proposing that these results may contribute to the clinical practice [61]. 

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