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Management of Glucocorticoid-Induced Osteoporosis – for Neurologists
  1. Juliet Compston, Professor of Bone Medicine and Honorary Consultant Physician
  1. Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge UK; Email: jec1001{at}cam.ac.uk

    Abstract

    INTRODUCTION

    Glucocorticoids are widely used by a number of medical specialists, including neurologists. A recent study using the UK General Practice Research Database identified 1.6 million oral glucocorticoid prescriptions over a 10-year period in 683 practices from different geographic areas of the UK (van Staa et al. 2000). At any one time, the prevalence of oral glucocorticoid use was 0.9% of the total adult population, rising to 2.5% of those aged 70–79 years. However, the use of bone active medication in this population was extremely low (5% used hormone replacement therapy and only 1.8% used bisphosphonates). And yet, osteoporosis is a common and serious complication of treatment with glucocorticoids, being associated with an increased risk of vertebral and hip fractures.

    Some important characteristics of glucocorticoid-induced bone loss have recently been identified:

    • Even during the first few months of therapy the onset of bone loss is rapid and the

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