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How to prevent glucocorticoid-induced osteoporosis

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To the Editor: We read with great interest the excellent review by Dore1 on the prevention of glucocorticoid-induced osteoporosis. As indicated by the author, bone loss is one of the most serious complications of corticosteroid therapy, causing significant costs, morbidity, and mortality related to vertebral and hip fractures. Therefore, prevention of bone loss is mandatory, and several drugs are available.

However, the author does not mention strontium ranelate in the armamentarium for this preventive treatment. Strontium ranelate is an orally administered treatment of postmenopausal osteoporosis, reducing the risk of vertebral and hip fractures, and its efficacy has been demonstrated in clinical and histologic studies.2,3 It has a particular mode of action, since it simultaneously inhibits bone resorption and stimulates bone formation.2,3 Only minor adverse effects have been reported, including gastrointestinal signs such as nausea and diarrhea (only during the first 3 months), headache, and skin lesions. Strontium ranelate is currently licensed for the treatment of postmenopausal osteoporosis, but it appears to be an effective solution for diverse fracture risks, including the treatment of glucocorticoid-induced osteoporosis.

In a 2-year observational, controlled study that included 107 patients with glucocorticoid-induced osteoporosis treated with strontium ranelate or risedronate, there was a significantly higher increase in lumbar spine and total hip bone mineral density and a stronger reduction in back pain in the group of patients treated with strontium ranelate than in the group of patients under risedronate therapy, but the number of patients with no new fractures was similar in both treatment groups.4

In an animal model, strontium ranelate was significantly superior to alendronate in the prevention of glucocorticoid-induced osteopenia according to bone mineral density and histomorphometric analysis.5

Therefore, we consider that strontium ranelate could also be effective in glucocorticoid-induced osteopenia prevention, but prospective studies are required.

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