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9. Anabolic therapy
Three randomized controlled trials have used anabolic therapy in the treatment of GIOP. One study each examined human parathyroid hormone, testosterone, and nandrolone decanoate. While the testosterone study examined men, the other two enrolled post-menopausal women. Results of the studies indicated that BMD of the lumbar spine and forearm increased in the treatment groups, whereas it decreased in the placebo groups following therapy. No effect was noted on the femoral neck, trochanter, total hip or distal radius BMD with human parathyroid hormone, and testosterone was found to have no effect on whole body BMD following therapy. Thus, anabolic therapy may have some benefit in the treatment of GIOP, however the prevention of glucocorticoid-induced osteoporosis with these agents needs to still be determined
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In general, if the course of glucocorticoid treatment is anticipated to be short (<3 months), individuals may continue on calcium and vitamin D supplementation. Calcium intake should be approximately 1500 mg per day, as a total of both dietary and supplemental sources, and vitamin D should be prescribed at a dose of 400–500 IU per day in individuals less than 65 years of age, and 800–1000 IU per day in older patients. Activated forms of vitamin D (calcitriol or alfacalcidol) have been shown to be more effective than vitamin D, however greater monitoring for hypercalciuria or hypercalcemia is required with these agents. If therapy is anticipated to go beyond the 3 month time frame then more effective bone-sparing treatment beyond calcium and vitamin D is required. For courses of glucocorticoid therapy greater than 3 months, a bisphosphonate should be prescribed. In the case of hypogonadal men, testosterone replacement should be considered. For post-menopausal women hormone replacement therapy should only be considered in those with menopausal symptoms that are affecting their quality of life, or in whom after explicit discussion of risk/benefit profile expresses a desire to initiate this therapy. Pre-menopausal women who do not plan to conceive may be prescribed a bisphosphonate. However, for those with future plans for childbirth, other agents such as calcitonin, calcium and vitamin D should be consider first. As bisphosphonates have extremely long half lives and the risks to the developing fetus even years from the time of termination of the bisphosphonate is yet unknown, these medications should be avoided in individuals who wish to conceive.
After 1 year of therapy, a follow-up bone density assessment should be performed, and if bone loss at a rate greater than 3% per year at any site measured has occurred then the intervention should be changed or an additional therapy added. If bone loss is less than 3% per year then treatment should be continued for the duration of the glucocorticoid therapy, and 3 years afterward in those with low bone mass. Bone mineral density should be reassessed every 2 years until glucocorticoid therapy is terminated. At this time, patients should then be assessed and managed in a manner similar to those not using glucocorticoids.
Из J Steroid Biochem Mol Biol. 2004 Apr;88(4-5):337-49.
The treatment of glucocorticoid-induced osteoporosis.
Cohen D, Adachi JD.
Как всегда, есть возможность ознакомиться с полным текстом (также есть недавний (2004) гайд от японцев по стероид-индуцир. остеопорозу)
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