Hormonal replacement therapy in the prevention and treatment of glucocorticoid-induced osteoporosis

Abstract

Hypogonadism is a complication of glucocorticoid therapy. Postmenopausal women on glucocorticoids suffer more fractures than premenopausal women on glucocorticoids. The use of oral contraceptives has been recommended in hypo- and amenorrhoeic premenopausal women receiving high doses of corticosteroids, as long as its use is compatible with other medical conditions of the patient. In post-menopausal women, the effect of hormonal replacement therapy in glucocorticoid-induced osteoporosis has only been studied in small prospective trials. These studies show an increase in bone density in the spine. The effect on hip bone density was not consistent. No data are available on the effect of hormonal replacement therapy on fracture incidence in glucocorticoid-induced osteoporosis. Bisphosphonates are an alternative for hormonal replacement therapy in women and men that do not tolerate hormonal replacement therapy or when contraindications for hormonal replacement therapy are present. Further prospective studies will be necessary before hormonal replacement therapy can be recommended in the prevention of glucocorticoid-induced osteoporosis in men and women.