Steroid induced osteoporosis


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Steroid induced osteoporosis

  2. 2. Chronic glucocorticoid excess hasdeleterious effects on bone thatcan lead to osteoporosis andfractures.
  3. 3. GLUCOCORTICOIDS AND BONE PHYSIOLOGY Glucocorticoids reduce bone formation and increase bone resorption. Glucocorticoids exert their effects on gene expression via cytoplasmic glucocorticoid receptors. In adult bone, glucocorticoid receptors are found in stromal cells & osteoblasts
  4. 4. Decreased bone formation — The predominant effect of glucocorticoids on the skeleton is reduced bone formation. The decline in bone formation may be mediated by direct inhibition of osteoblast proliferation and by stimulation of apoptosis of osteoblasts .
  5. 5. Decreased calcium absorption — Glucocorticoids decrease intestinal calcium absorptionIncreased calcium excretion — Glucocorticoids increase renal calcium excretion by decreasing calcium reabsorptionThe effects are pronounced with daily therapy, may be less with alternate-day therapy.
  6. 6. CLINICAL ASPECTS OF GLUCOCORTICOID- INDUCED BONE LOSS A prospective, longitudinal study found that patients beginning high-dose glucocorticoid therapy (mean dose 21 mg/day) lost a mean of 27% of their lumbar spine bone density during the first year. There is a substantial increase in fracture risk in patients receiving glucocorticoid therapy that appears within three to six months of initiating treatment. Fracture risk appears to be related to the dose and duration of therapy.
  7. 7.  Bone density usually increases after discontinuation of exogenous glucocorticoids
  8. 8. Prevention and treatment of glucocorticoid-induced osteoporosisGENERAL MEASURES — Attempts to reverse the glucocorticoid excess by decreasing the dose of exogenous glucocorticoid The glucocorticoid dose and the duration of therapy should be as low as possible.
  9. 9.  When glucocorticoids are given, topical therapy (such as inhaled glucocorticoids for asthma & glucocorticoid enemas for bowel disease) is preferred. Consider short-term high-dose pulse therapy instead of continuous therapy for weeks or months . Patients should be encouraged to do weight- bearing exercises for at least 30 minutes each day . Patients should avoid smoking and excess alcohol.
  10. 10. CALCIUM AND VITAMIN DThe American College of Rheumatology (ACR) recommends the following Maintain a calcium intake of 1000 to 1500 mg/day Vitamin D intake of 800 IU/day
  11. 11. BISPHOSPHONATES - (Eg- ALENDRONATE, ETIDRNATE) These drugs prevent glucocorticoid-induced bone loss by prolonging the lifespan of osteoblasts. Total body bone density increased significantly with the alendronate treatment.
  12. 12. The American College of Rheumatology (ACR) guidelines recommends the following interventions in patients initiating prednisone in a dose of 5 mg/day or higher for more than three months and for patients receiving long term glucocorticoids in whom the BMD T-score is below -1.0. • Bisphosphonate therapy alendronate 35 mg/week for prevention, 70 mg/week for treatment Consideration of calcitonin therapy if bisphosphonates are contraindicated or not tolerated.( dose of 200 IU/day)
  13. 13. CONTRA-INDICATIONS Abnormalities of oeaophagus – Eg-stricture,Achalasia. Hypocalcemia Preganancy & Breast-feeding
  14. 14. SIDE-EFFECTS Peptic ulceration Abdominal pain & distension Dyspepsia & regurgitation Osteonecrosis of the jaw
  15. 15. Patient information Drugs need to be taken in the morning on an empty stomach with a full 8 oz glass of plain water. The person must then wait for at least half an hour before eating or taking any other medications. These dosing instructions help to reduce the risk of side effects and potential complications.
  16. 16. THANK YOU