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?
Step 1: Take Control Naturally with optimal levels of Vitamin D3 and absorbable calcium. Calcium Citrate or other absorbable calciums are important since glucocorticoids can decrease stomach acid and absorption of Calcium Carbonate.
Step 2: Get a complete bone health evaluation as a baseline. Every person expected to be on Prednisone, Cortisone, or other steroids for more than 3 months in their lifetime needs repeated evaluations. This allows implementation of step 1. Repeat evaluations tell when step 3 is needed.
Step 3: Take medication as needed. GIOP suppresses Osteoblasts and new bone formation. Only an anabolic can stimulate osteoblasts. Forteo (Teriparatide) is the obvious choice to stimulate osteoblasts. Forteo is currently recommended for a total of 2 years. Often steroid use is anticipated to last for many years.
Researchers suggest using Forteo for 6-12 months at a time with intervals of 1-2 years of Antiresorptives in between to preserve bone mass. This timing is “off label” but promises to preserve or even improve bone for up to 10 years.
Beware of GIOP. Act early to prevent bone loss as much as possible. More next time.
Jay Ginther, MD