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2015 ; 1
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): e000014
Nephropedia Template TP
RMD Open
2015[]; 1
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PMID26509049
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Corticosteroid-induced osteoporosis is the most common form of secondary
osteoporosis and the first cause in young people. Bone loss and increased rate of
fractures occur early after the initiation of corticosteroid therapy, and are
then related to dosage and treatment duration. The increase in fracture risk is
not fully assessed by bone mineral density measurements, as it is also related to
alteration of bone quality and increased risk of falls. In patients with
rheumatoid arthritis, a treat-to-target strategy focusing on low disease activity
including through the use of low dose of prednisone, is a key determinant of bone
loss prevention. Bone loss magnitude is variable and there is no clearly
identified predictor of the individual risk of fracture. Prevention or treatment
of osteoporosis should be considered in all patients who receive prednisone.
Bisphosphonates and the anabolic agent parathyroid hormone (1-34) have shown
their efficacy in the treatment of corticosteroid-induced osteoporosis. Recent
international guidelines are available and should guide management of
corticosteroid-induced osteoporosis, which remains under-diagnosed and
under-treated. Duration of antiosteoporotic treatment should be discussed at the
individual level, depending on the subject's characteristics and on the
underlying inflammation evolution.
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