What are the Treatments for Glucocorticoid Induced Osteoporosis?
In an ironic twist of fate, individuals who have been prescribed glucocorticoid medications (prednisone, prednisolone, cortisone, and dexamethasone) are at risk for developing osteoporosis. Although glucocorticoid is often prescribed for rheumatoid arthritis or other rheumatic diseases, the medication is also prescribed for other conditions too. Therefore, an individual does not have to have an existing arthritis condition in order for this medication to result in the development of one. Oddly enough, other medications are the recommended treatment for this condition caused by a medication.
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Treatments
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Supplements (calcium and vitamin D) and exercise, as well as the following medications and hormones, are used to treat glucocorticoid-induced osteoporosis: bisphosphonates, calcitonin, estrogen or hormone replacement therapy, selective estrogen receptor modulators, teriparatide and strontium ranelate.
Calcium Treatment
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Individuals with glucocorticoid-induced osteoporosis who have not reached menopause should take a minimum of 1,000 milligrams (mg) of calcium per day. After menopause that minimum would be 1,500 mg per day. Once glucocorticoid medication is ceased, however, this dosage should be reviewed and reduced unless the individual already had osteoporosis or is postmenopausal.
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Vitamin D Treatment
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In order for the body to absorb the calcium we ingest, our body must have adequate levels of vitamin D. Recommended dosage intake of vitamin D, per the American College of Rheumatology, for glucocorticoid-induced osteoporosis is as follows (see link in the Resources section below): a minimum of 400 IU each day for those under the age of 60 and between 600 and 800 IU a day if over 60 years of age.
Exercise
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Weight-bearing exercise is also a recommended treatment for glucocorticoid-induced osteoporosis. Exercise machines and dumbbells or barbells are considered weight-bearing, as well as walking.
Medications
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The bisphosphonate medication types that can be used by postmenopausal women as well as men in the treatment of glucocorticoid-induced osteoporosis are alendronate and risedronate. Both are FDA-approved. Currently, these medications are not recommended for pregnant women (or those seeking to become pregnant or who are breastfeeding).
Calcitonin, a thyroid gland produced hormone medication that is typically administered by injection or via nasal spray, is considered safe for pregnant women.
Hormones
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Estrogen and hormone replacement therapy (HRT) aids in glucocorticoid-induced osteoporosis by helping to prevent further bone loss or fractures. However, an increase in the risk of strokes is possible, as well as some types of cancers; therefore, your physician will need to guide you in hormones used to treat this type of osteoporosis.
Selective estrogen receptor modulator (SERM) medications provide the positive benefits reaped from estrogen, without all of the side effects that can occur (e.g., breast cancer), according to the American College of Rheumatology (see link in Resources). In addition, if you are postmenopausal, do not have a history of radiation treatment for your parathyroid--or too high levels of it--you also have the option of using the injection version of teriparatide medication, which can stimulate needed bone formation.
Other Treatments
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Strontium ranelate is a medication administered in powder form. However, it is only available in Europe at present, not the United States. And although it reduces the risk of fractures in postmenopausal women, it increases the risk of blood clots.
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