What is the recommended first-line agent to prevent steroid-induced osteoporosis?

What is the recommended first-line agent to prevent steroid-induced osteoporosis?

• A. Bisphosphonates
• B. Calcitonin
• C. Raloxifene
• D. Denosumab

Answer: (A)

Steroid-induced osteoporosis happens because glucocorticoids both reduce bone formation and increase bone resorption, causing rapid bone loss. The first-line pharmacologic approach to prevent this is a bisphosphonate (for example, alendronate or risedronate). Bisphosphonates strongly inhibit osteoclast-mediated bone resorption, directly countering the accelerated bone loss seen with glucocorticoids, and they have the strongest evidence showing reduced fracture risk in patients on chronic steroids. Other agents can be effective in different contexts, but they don’t have the same robust data for prevention of glucocorticoid-induced bone loss as a first-line therapy. Calcitonin tends to have limited efficacy; raloxifene is not the preferred option for this setting; denosumab is effective but is typically considered after or instead of bisphosphonates when bisphosphonates aren’t suitable. In practice, pair this with calcium and vitamin D optimization and monitor bone density as needed.

Steroid-induced osteoporosis happens because glucocorticoids both reduce bone formation and increase bone resorption, causing rapid bone loss. The first-line pharmacologic approach to prevent this is a bisphosphonate (for example, alendronate or risedronate). Bisphosphonates strongly inhibit osteoclast-mediated bone resorption, directly countering the accelerated bone loss seen with glucocorticoids, and they have the strongest evidence showing reduced fracture risk in patients on chronic steroids. Other agents can be effective in different contexts, but they don’t have the same robust data for prevention of glucocorticoid-induced bone loss as a first-line therapy. Calcitonin tends to have limited efficacy; raloxifene is not the preferred option for this setting; denosumab is effective but is typically considered after or instead of bisphosphonates when bisphosphonates aren’t suitable. In practice, pair this with calcium and vitamin D optimization and monitor bone density as needed.