Nancy Murphy, MD Nancy Murphy, MD Robert L. Meckelnburg,
MD Mahaveer Prabhakar, MD

Brandywine Plaza, Ste 114 Brandywine Plaza,
Ste 114 400 Christiana Medical Center 1 Village Drive

2500 Grubb Rd 2500 Grubb Road Newark, DE 19702 Cape May Court House
Wilmington, DE 19810 Wilmington, DE 19810 302-368-8700 N.J. 08210
302-529-0373 302-529-0373 e-mail: osteorec@prodigy.net 609-465-2774

GLUCOCORTICOID INDUCED OSTEOPOROSIS

Glucocorticoids both enhance bone resorption and decrease bone formation. In the initial therapy phase with glucocorticoids there is a profound osteoblast suppression and early stimulation of bone resorption. Glucocorticoids also decrease gastrointestinal calcium absorption, increase urinary calcium excretion, decrease serum calcium, and enhance parathyroid hormone secretion. In addition glucocorticoids are hypogonadal decreasing estrogen, testosterone and adrenal androgens. Recently it has become apparent that glucocorticoids affect cytokines that play a vital role in osteoblast-osteoclast interaction. One of these cytokines is Rank Ligand which is essential for osteoclastogenesis.

Risedronate has been used for both the prevention and treatment of glucocorticoid induced osteoporosis. In a prevention trial of 228 patients that was randomized and double blinded, all patients on Risedronate showed maintenance of bone mineral density while those on placebo demonstrated a progressive and significant bone loss. In the treatment trial program which was defined as patients on glucocorticoids for greater than six months and at a dose of 7.5 mg or more, this multi-centered double blinded trial of 290 patients showed a significant increase in bone mineral density in both the hip and the spine compared to base line and the placebo group.

When both the prevention and treatment trials were combined there was a 70 percent reduction in the incidence of vertebral fractures compared with the controlled population. In the controlled group the incidence was 16.3 percent and in the treatment group only 5.45 percent. In both trials, oral Risedronate was well tolerated and efficacious. Bisphosphonate therapy has consistently shown excellent results in the treatment of glucocorticoid-induced osteoporosis and its prevention. Risedronate is approved for both the prevention and treatment of glucocorticoid induced osteoporosis and demonstrates a means of avoiding an otherwise serious complication of steroid treatment.