Treating glucocorticoid-induced osteoporosis

Treating glucocorticoid-induced osteoporosis

For patients with glucocorticoid-induced osteoporosis, a once-yearly infusion of zoledronic acid is as effective as daily risedronate for the prevention and treatment of bone loss according to a new study from Lancet. In a 1-year, international, randomized, double-blind, placebo-controlled, non-inferiority study, 833 patients with glucocorticoid-induced osteoporosis were randomized to receive zoledronic acid 5 mg as a 100 mL IV infusion over 15-20 minutes on day 1 plus oral placebo or 5 mg of risedronate daily and 100 mL IV placebo infusion on day 1. Patients were allocated to a prevention or treatment subgroup depending on the duration of glucocorticoid use preceding study. Zoledronic acid infusion was non-inferior and superior to risedronate for increase of lumbar spine bone mineral density in both the treatment (P = 0.001) and prevention groups (P < 0.0001), respectively. Adverse events were more frequent in patients given zoledronic acid primarily because of increased flu-like symptoms within the first 3 days after the infusion. The authors conclude that a single 5 mg intravenous infusion of zoledronic acid is non-inferior and possibly more effective and more acceptable to patients than 5 mg of oral risedronate daily for prevention and treatment of bone loss associated with glucocorticoid use (Lancet 2009;373:1253-1263). An accompanying editorial suggests that once-yearly zoledronic acid seems to have obvious advantages over an oral regimen but the long-term safety is still unknown and also raises the question of whether anabolic drugs, such as teriparatide, which stimulate bone formation by acting on osteoblasts and osteocytes, might eventually be a better option (Lancet 2009;373:1225-1226).