ABSTRACT Glucocorticoids are universally used in therapy of numerous, sometimes life-threatening conditions. Owing to their pharmacological properties, they represent an irreplaceable therapeutic tool. However, their use is not devoid of complications. One of the most dreadful side-effects consists of osteoporosis, with its host of crippling fractures. The fact that the adverse skeletal effects manifest rapidly after initiation of glucocorticoids implicates that preventative measures should be instituted as soon as possible. However, even currently, this is not yet a systematic procedure. Still, several therapies exist in order to counteract bone loss induced by glucocorticoids, most of them are based on pathophysiology of the condition. The first step is to obviate the diminished intestinal calcium absorption induced by glucocorticoids, by using calcium and vitamin D supplementation. However, this simple measure proves rarely to be efficacious enough. Several bone promotors and bone antiresorbing agents have been proposed, the most studied being bisphosphonates. However, most of the studies have not been tailored as to be able to demonstrate antifracture efficacy. Aminobisphosphonates such as alendronate and risedronate are the most effective agents in this aim. Bone protection should be considered in every patient put on supraphysiologic doses of glucocorticoids for an expected treatment duration exceeding 3 months.
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