Glucocorticoid-Induced Osteoporosis (GIO)

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Glucocorticoid-Induced Osteoporosis (GIO)

• Nguyen Thy Khue, MD, PhD
• Department of Endocrinology,
• HoChiMinh City University of Medicine and Pharmacy

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Epidemiology of GIO

• Prevalence of oral glucocorticoid use 1 of
  the adult population1
• 2.5 in individuals aged 70-79
• Up to 350,000 individuals in UK at risk of
  fractures due to glucocorticoid use

(Van Staa TP et al, 2000)
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GC in developing countries

• Prevalence unknown.
• Glucocorticoid can be purchased over the counter.

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Projected number of glucocorticoid use among 50
Number of individuals using glucocorticoid
(x1000)
Prevalence of using glucocorticoid
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Mechanism of Corticosteroid Induced Osteoporosis
(Segal L G et al. 1997)
D1202
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Effect of steroids on bone mineral density
Months
p lt0.01 vs. baseline

Bone change vs baseline


( Mulder H et al. 1994)
D1202
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Factors associated with fracture risk with GC Rx

• Age
• BMD
• Initial subsequent to GC Rx.
• Postmenopausal women highest risk.
• Glucorticoid dose cumulative mean daily dose.
• Duration of exposure.
• Underlying diseases.

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Fracture type and the use of Glucocorticoid
Fracture type Gender Corticosteroid use Prior fracture
Any fracture M 1.7 (1.12.5) 1.7 (1.42.1 )
F 1.4 (1.21.6) 1.7 (1.61.9)
Osteoporotic fracture M 2.2 (1.43.3) 1.7 (1.42.1)
F 1.4 (1.21.7) 1.7 (1.61.9)
Hip fracture M 2.6 (0.97.5) 1.7 (1.02.9)
F 2.1 (1.43.1) 1.7 (1.32.1)
(Kanis JA, et al, 2004)
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Projected number of GC-induced fractures per year
for men and women aged 50
Any fracture
Hip fracture
Prevalence of using glucocorticoid
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Incidence of non-vertebral fractures (per 100
p-yrs) in women
244.235 oral GC users 244.235 controls 58.6
female
(van Staa et al, 2000)
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Incidence of non-vertebral fracture before,
during and after steroid therapy
24 1 6 60 3 30
van Staa JBMR 2000
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Steroid therapy
Bone Strength
A B
C
D E
3 to 6 months
3 to 6 months
Time
A osteocyte apoptosis C accumulation of D
fast repair of defects B fast bone loss
unrepaired defects E restoration of osteocytes
(Manolagas et al, 2000)
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Treatment of GIO

• Primary prevention
• Most rapid bone loss within 1st 6 12 months of
  Rx
• Secondary prevention

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Prevention of Glucocorticoid -induced bone loss

• Use lowest dose GC possible.
• Minimise lifestyle risk factors quit smoking.
• Individualised exercise programmes.
• Drug Rx.

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Drug treatment of osteoporosis

• Anti-resorptives
• Bisphosphonates
• HRT/SERMS
• Calcitonin
• Anabolics
• Teriparatide
• Strontium ranelate
• Calcium Vitamin D for all patients

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CLINICAL PRESENTATION
GC doses Prednisone gt5mg/d for gt 3
mo Additional Risk Factors    Postmenopausal  
  Male gt 50 y    Low weight    Prior
fracture    High dose of prednisone
(gt10mg/day)    Underlying disease with rapid
bone loss . Immobilized due to underlying
disease . Low calcium intake   Family
history of osteoporosis
 
(Sambrook PN)
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Cost of treatment

• Bisphosphonates (alendronate) 280 per
  patient/year
• Individuals age 50 using GC 1M (based on 10
  of prevalence of using GC)
• Number of fractured cases reduced 5240
• Treatment cost for prevention of one fracture
  53,579 USD

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Summary

• Glucocorticoids widely used in clinical practice.
• gt7.5mg/day Pednisone for gt3-6 m of therapy, but
  no absolute cutoff below which GC treatment safe.

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Summary

• Rapid bone loss (3-6 months) ? early prevention.
• Consideration for prevention
• fracture risk assessment
• Effect of underlying disease
• Effect of GC and other drugs on skeleton
• Bisphosphonates the mainstay of therapy.

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Thank you