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CC BY-NC-ND 4.0 · Horm Metab Res 2023; 55(08): 511-519
DOI: 10.1055/a-2112-1596
Review

Pharmacological Interventions for Glucocorticoid-Induced Osteoporosis: An Umbrella Review

Haodong Liang
1   The Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou, China
,
Jinlong Zhao
1   The Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou, China
,
Tianzhao Tian
1   The Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou, China
› Author Affiliations Funding Information Health Technology Project of Guangzhou — No. 20222A010019 Administration of Traditional Chinese Medicine of Guangdong Province — No. 20221323
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Abstract

There is still a lack of high-quality evidence-based studies on the efficacy of drug treatment for glucocorticoid-induced osteoporosis (GIOP). The purpose of this umbrella review is to comprehensively evaluate the existing evidence to determine the efficacy and safety of pharmacological interventions for GIOP. We searched PubMed, Embase, and the Cochrane Library for systematic reviews and/or meta-analyses (SRs) of randomized controlled trials (RCTs) aimed at evaluating drug therapy for GIOP. Both the methodological quality and the strength of recommendation of the endpoints included in the SRs were evaluated by using the AMSTAR-2 tool and GRADE system, respectively. Six SRs involving 7225 GIOP patients in 59 RCTs were included in this umbrella review. The results of the methodological quality evaluation showed that 2 high-quality, 2 low-quality and 2 critically low-quality SRs were included. The GRADE evaluation results showed that the quality of evidence and the strength of recommendation of 46 outcome indicators were evaluated in the umbrella review; there were 3 with high-level evidence, 20 with moderate-level evidence, 15 with low-level evidence, and 8 with very low-level evidence. Moderate- to high-level evidence suggests that teriparatide, bisphosphonates, and denosumab can improve the bone mineral density in patients with GIOP. The findings of this umbrella review can enable patients and clinical healthcare professionals to choose the best drug prescription.

Key words

glucocorticoid-induced osteoporosis - umbrella review - efficacy - safety - pharmacotherapy


Publication History

Received: 15 May 2023

Accepted after revision: 19 June 2023

Accepted Manuscript online:
19 June 2023

Article published online:
31 July 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Wang T, Liu X, He C. Glucocorticoid-induced autophagy and apoptosis in bone. Apoptosis 2020; 25: 157-168
    CrossrefPubMedGoogle Scholar
  • 2 Xia X, Kar R, Gluhak-Heinrich J. et al. Glucocorticoid-induced autophagy in osteocytes. J. Bone Mine. Res 2010; 25: 2479-2488
    CrossrefPubMedGoogle Scholar
  • 3 Banuelos J, Shin S, Cao Y. et al. BCL-2 protects human and mouse Th17 cells from glucocorticoid-induced apoptosis. Allergy 2016; 71: 640-650
    CrossrefPubMedGoogle Scholar
  • 4 Messina OD, Vidal LF, Wilman MV. et al. Management of glucocorticoid-induced osteoporosis. Aging Clin Exp Res 2021; 33: 793-804
    CrossrefPubMedGoogle Scholar
  • 5 Fardet L, Petersen I, Nazareth I. Monitoring of patients on long-term glucocorticoid therapy. Medicine 2015; 94: e647
    CrossrefPubMedGoogle Scholar
  • 6 Weinstein RS. Glucocorticoid-induced bone disease. New Engl J Med 2011; 365: 62-70
    CrossrefPubMedGoogle Scholar
  • 7 De Vries F, Bracke M, Leufkens HGM. et al. Fracture risk with intermittent high-dose oral glucocorticoid therapy. Arthrit Rheuma 2007; 56: 208-214
    CrossrefPubMedGoogle Scholar
  • 8 van Staa TP, Leufkens HG, Cooper C. Use of inhaled corticosteroids and risk of fractures. J Bone Miner Res 2001; 16: 581-588
    CrossrefPubMedGoogle Scholar
  • 9 Compston JE, McClung MR, Leslie WD. Osteoporosis. Lancet 2019; 393: 364-376
    CrossrefPubMedGoogle Scholar
  • 10 Chotiyarnwong P, McCloskey EV. Pathogenesis of glucocorticoid-induced osteoporosis and options for treatment. Nat Rev Endocrinol 2020; 16: 437-447
    CrossrefPubMedGoogle Scholar
  • 11 Compston J. Glucocorticoid-induced osteoporosis: an update. Endocrine 2018; 61: 7-16
    CrossrefPubMedGoogle Scholar
  • 12 Buckley L, Guyatt G, Fink HA. et al. 2017 American college of rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthrit Care Res 2017; 69: 1095-1110
    CrossrefPubMedGoogle Scholar
  • 13 Faulkner G, Fagan MJ, Lee J. Umbrella reviews (systematic review of reviews). Int Rev Sport Exerc Psychol 2022; 15: 73-90
    CrossrefPubMedGoogle Scholar
  • 14 Pollock M, Fernandes RM, Becker LA. et al. Chapter V: Overviews of reviews. In: Higgins JPT, Thomas J, Chandler J et al. (eds). Cochrane handbook for systematic reviews of interventions version 6.2. The Cochrane Collaboration, 2021; Available at: http://www.cochrane-handbook.org
    PubMed
  • 15 Shea BJ, Reeves BC, Wells G. et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 2017; 358: j4008
    CrossrefPubMedGoogle Scholar
  • 16 Guyatt Oxman GAD, Akl EA. et al. GRADE guidelines: 1. Introduction- GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011; 64: 383-394
    CrossrefPubMedGoogle Scholar
  • 17 Allen CS, eung JH, Vandermeer B. et al. Bisphosphonates for steroid-induced osteoporosis. Cochrane Db. Syst Rev 2016; 10: CD001347
    PubMedGoogle Scholar
  • 18 Homik J, Suarez-Almazor ME, Shea B. et al Calcium and vitamin D for corticosteroid-induced osteoporosis. Cochrane Db. Syst Rev 2000; 1998 CD000952
    PubMedGoogle Scholar
  • 19 Liu Z, Zhang M, Zong Y. et al. The efficiency and safety of alendronate versus teriparatide for treatment glucocorticoid-induced osteoporosis: A meta-analysis and systematic review of randomized controlled trials. PLoS One 2022; 17: e0267706
    CrossrefPubMedGoogle Scholar
  • 20 Wang Y, Zhang Y, Qin S. et al. Effects of alendronate for treatment of glucocorticoid-induced osteoporosis. Medicine 2018; 97: e12691
    CrossrefPubMedGoogle Scholar
  • 21 Wang J, Li H. Treatment of glucocorticoid-induced osteoporosis with bisphosphonates alone, vitamin D alone or a combination treatment in Eastern Asians: a meta-analysis. Curr Pharm Design 2019; 25: 1653
    CrossrefPubMedGoogle Scholar
  • 22 Yanbeiy ZA, Hansen KE. Denosumab in the treatment of glucocorticoid-induced osteoporosis: a systematic review and meta-analysis. Drug Des Devel Ther 2019; 13: 2843-2852
    CrossrefPubMedGoogle Scholar
  • 23 Oura P, Karppinen J, Niinimäki J. et al. Sex estimation from dimensions of the fourth lumbar vertebra in Northern Finns of 20, 30, and 46 years of age. Forensic Sci Int 2018; 290: 350.e1-e6
    CrossrefPubMedGoogle Scholar
  • 24 Zeng Y, Huang C, Duan D. et al. Injectable temperature-sensitive hydrogel system incorporating deferoxamine-loaded microspheres promotes H-type blood vessel-related bone repair of a critical size femoral defect. Acta Biomater 2022; 153: 108-123
    CrossrefPubMedGoogle Scholar
  • 25 Kim KJ, Min YK, Koh JM. et al. Efficacy and safety of weekly alendronate plus vitamin D₃ 5600 IU versus weekly alendronate alone in Korean osteoporotic women: 16-week randomized trial. Yonsei Med J 2014; 55: 715-724
    CrossrefPubMedGoogle Scholar
  • 26 Finkelstein JS, Hayes A, Hunzelman JL. et al. The effects of parathyroid hormone, alendronate, or both in men with osteoporosis. N Engl J Med 2003; 349: 1216-1226
    CrossrefPubMedGoogle Scholar
  • 27 Valenti MT, Giannini S, Donatelli L. et al. The effect of risedronate on osteogenic lineage is mediated by cyclooxygenase-2 gene upregulation. Arthrit Res Ther 2010; 12: R163
    CrossrefPubMedGoogle Scholar
  • 28 Bouxsein ML, Chen P, Glass EV. et al. Teriparatide and raloxifene reduce the risk of new adjacent vertebral fractures in postmenopausal women with osteoporosis. Results from two randomized controlled trials. J Bone Joint Surg Am 2009; 91: 1329-1338
    CrossrefPubMedGoogle Scholar