Posts Tagged ‘Bone Turnover’
GIOP From Steroid Inhalers & Injections
Glucocorticoid Induced OsteoPorosis is more common than we thought. Individuals with Rheumatoid arthritis, fibromyalgia, and other inflamatory diseases often need Prednisone and other steroids (glucocorticoids). 3 months of Prednisone 5 mg or more daily induces GIOP. 3-6 months of Prednisone at over 2.5 mg daily can also lead to GIOP. And both of these are total lifetime dose.
Many inhalers for asthma and COPD also contain steroids. Steroids suppress OsteoBlasts, the cells that make new bone to replace resorbed bone. A year or more of inhalers is thought to be the threshhold for ill effects.
Now we are finding out about “Cortisone” (glucocorticoid) Injections into knees and other joints.
Beware of GIOP
GIOP is Glucocorticoid Induced OsteoPorosis. Cortisone, Prednisone, and many Inhalers for Asthma or COPD are glucocorticoids. Therefore, Glucocorticoid Induced OsteoPorosis is a particularly aggressive form of osteoporosis that affects all ages, not just older adults.
Glucocorticoids suppress OsteoBlasts, the cells that make new bone. Even the normal rate of bone turnover required for good bone maintenence and repair of microcracks becomes a problem when new bone formation is suppressed. Persons with GIOP have a rapid decline in bone quality and strength. What can be done?
Interesting Medication Combinations from ASBMR
Studies of combinations of osteoporosis medications expanded at the American Society for Bone and Mineral Research (ASBMR) 2012. Previous meetings featured alternating the anabolic, Teriparatide (Forteo) with a Bisphosphonate Antiresorptive, usually Alendronate (generic Fosamax), and, more recently, simultaneous Alendronate and Forteo. This time we heard about the first study of Denosumab (Prolia) combined with Forteo. [Disclosure: I am on the Orthopedic Advisory Board for Prolia, and Speakers Bureau for Forteo]
The Bone Mineral Density (BMD) increase at one year was much better for the combination than for either drug alone. This is the same effect we have seen with previous combinations, but higher BMD numbers. This study had small numbers of patients (<200), and a short period of time (<2 years). It is not clear, whether the greater BMD of this combination is of any significance, and how well it will hold up over time. Also, BMD is not the whole story.