Original Article
Densitometry in Glucocorticoid-Induced Osteoporosis

https://doi.org/10.1385/JCD:7:4:359Get rights and content

Abstract

Bone density measurement is a critical tool in the management of glucocorticoid-induced osteoporosis (GIOP). This review addresses the utility of various measurement devices (dual-energy X-ray absorptiometry [DXA], quantitative ultrasound [QUS], quantitative CAT scanning [QCT]), their role in monitoring changes in bone mineral density (BMD), and the relationship of BMD and fracture risk in GIOP. A higher BMD threshold should be utilized for estimating fracture risk in patients on glucocorticoids.

References (43)

  • KG Saag et al.

    Low dose long-term corticosteroid therapy in rheumatoid arthritis: an analysis of serious adverse events

    J Med

    (1994)
  • KG Faulkner et al.

    Discordance in patient classification using T-scores

    J Clin Densitom

    (1999)
  • H Cushing

    The basophil adenomas of the pituitary body and their clinical manifestations (pituitary basophilism)

    Bull John Hopkins Hosp

    (1932)
  • PH Curtis et al.

    Vertebral fractures resulting from prolonged cortisone and corticotropin therapy

    JAMA

    (1954)
  • T van Staa et al.

    Use of oral corticosteroids and risk of fractures

    J Bone Miner Res

    (2000)
  • TP van Staa et al.

    Oral corticosteroids and fracture risk: relationship to daily and cumulative doses

    Rheumatology

    (2000)
  • TP Van Staa et al.

    Bone density threshold and other predictors of vertebral fracture in patients receiving oral glucocorticoid therapy

    Arthritis Rheum

    (2003)
  • KG Saag et al.

    Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis. Glucocorticoid-Induced Osteoporosis Intervention Study Group

    N Engl J Med

    (1998)
  • S Cohen et al.

    Risedronate therapy prevents corticosteroid-induced bone loss

    Arthritis Rheum

    (1999)
  • JD Adachi et al.

    Intermittent cyclical etidronate therapy in the prevention of corticosteroid-induced osteoporosis

    N Engl J Med

    (1997)
  • Recommendation for the prevention and treatment of glucocorticoid-induced osteoporosis

    Arthritis Rheum

    (2001)
  • Guidelines on the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis

    (2003)
  • RA Yood et al.

    Prevention of glucocorticoid-induced osteoporosis: Experience in a managed care setting

    Arch Intern Med

    (2001)
  • LC Hofbauer et al.

    Stimulation of osteoprotegerin ligand and inhibition of osteoprotegerin production by glucocorticoids in human osteoblastic lineage cells: potential paracrine mechanisms of glucocorticoid-induced osteoporosis

    Endocrinology

    (1999)
  • RS Weinstein et al.

    Inhibition of osteoblastogenesis and promotion of apoptosis of osteoblasts and osteocytes by glucocorticoids: potential mechanisms of their deleterious effects on bone

    J Clin Invest

    (1998)
  • RS Weinstein et al.

    Inhibition of osteoblastogenesis and promotion of apoptosis of osteoblasts and osteocytes by glucocorticoids: potential mechanisms of their deleterious effects on bone

    J Clin Invest

    (1998)
  • RS Weinstein et al.

    Preservation of osteocyte viability by bisphosphonates contributes to bone strength in glucocorticoid-treated mice independently of BMD: an unappreciated determinant of bone strength

    J Bone Miner Res

    (2002)
  • RF Laan et al.

    Low-dose prednisone induces rapid reversible axial bone loss in patients with rheumatoid arthritis

    Ann Intern Med

    (1993)
  • RC Butler et al.

    Bone mineral content in patients with rheumatoid arthritis: relationship to low-dose steroid therapy

    Br J Rheum

    (1991)
  • GM Hall et al.

    The effect of rheumatoid arthritis and steroid therapy on bone density in postmenopausal women

    Arthritis Rheum

    (1993)
  • PN Sambrook et al.

    Osteoporosis in rheumatoid arthritis: saftey of low dose corticosteroids

    Ann Rheum Dis

    (1986)
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