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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 – PowerPoint PPT presentation

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Title: Glucocorticoid-Induced Osteoporosis (GIO)


1
Glucocorticoid-Induced Osteoporosis (GIO)
  • Nguyen Thy Khue, MD, PhD
  • Department of Endocrinology,
  • HoChiMinh City University of Medicine and Pharmacy

2
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)
3
GC in developing countries
  • Prevalence unknown.
  • Glucocorticoid can be purchased over the counter.

4
Projected number of glucocorticoid use among 50
Number of individuals using glucocorticoid
(x1000)
Prevalence of using glucocorticoid
5
Mechanism of Corticosteroid Induced Osteoporosis
(Segal L G et al. 1997)
D1202
6
Effect of steroids on bone mineral density
Months
p lt0.01 vs. baseline

Bone change vs baseline


( Mulder H et al. 1994)
D1202
7
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.

8
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)
9
Projected number of GC-induced fractures per year
for men and women aged 50
Any fracture
Hip fracture
Prevalence of using glucocorticoid
10
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)
11
Incidence of non-vertebral fracture before,
during and after steroid therapy
24 1 6 60 3 30
van Staa JBMR 2000
12
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)
13
Treatment of GIO
  • Primary prevention
  • Most rapid bone loss within 1st 6 12 months of
    Rx
  • Secondary prevention

14
Prevention of Glucocorticoid -induced bone loss
  • Use lowest dose GC possible.
  • Minimise lifestyle risk factors quit smoking.
  • Individualised exercise programmes.
  • Drug Rx.

15
Drug treatment of osteoporosis
  • Anti-resorptives
  • Bisphosphonates
  • HRT/SERMS
  • Calcitonin
  • Anabolics
  • Teriparatide
  • Strontium ranelate
  • Calcium Vitamin D for all patients

16
(No Transcript)
17
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)
18
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

19
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.

20
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.

21
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