Significant reduction of the mass of bone metastasis 1 year after rhenium-186 HEDP pain palliation therapy

A 59-year-old man with prostate cancer and pain from multiple bone metastases was treated with 1,424 MBq (38.5 mCi) rhenium-186 hydroxyethylidene diphosphonate (Re-186 HEDP). In addition, he had nonsteroidal antiandrogen, progestagen, and an analog-luteinizing hormone. Neither chemotherapy nor external-beam radiotherapy was administered. Bisphosponate therapy was stopped 4 weeks before the administration of Re-186 HEDP. The Tc-99m HMDP whole-body scan obtained 6 weeks after therapy showed the same results as before therapy. However, 1 year after therapy, a significant reduction of the mass of the metastases was visible on bone scan. The bone scan index decreased from 34 before therapy to 10 after 1 year. The patient described significant pain relief and stopped his analgesic intake 3 weeks after therapy.

An endoscopic comparison of the effects of alendronate and risedronate on upper gastrointestinal mucosae

OBJECTIVES

The nitrogen-containing bisphosphonates alendronate and risedronate have been reported to have upper gastrointestinal (GI) safety and tolerability profiles comparable to those of placebo. Nevertheless, both agents have demonstrated similar potential for irritation of gastric mucosa at high doses in preclinical studies. The present study compared the potential for alendronate and risedronate to produce endoscopic upper GI mucosal irritation using the highest approved dosage regimens for the two agents.

METHODS

This was a multicenter, randomized, parallel-group, double-blind, placebo-controlled trial in which a total of 235 patients (men or postmenopausal women, aged 45-80 yr) with normal upper GI endoscopy at baseline received 28-day treatments with the following: alendronate 40 mg/day (N = 90), risedronate 30 mg/day (N = 89), placebo (N = 36), or placebo with aspirin 650 mg q.i.d. for the last 7 days (N = 20). Endoscopy was repeated on day 29 using standardized scoring scales.

RESULTS

After 28 days of treatment, the alendronate and risedronate groups had comparable mean gastric and duodenal erosion scores that were significantly lower than those of the aspirin group. Esophageal scores were comparable in all groups. Gastric ulcers and/or large numbers of gastric erosions occurred in approximately 3% of alendronate and risedronate patients versus 60% with aspirin. Both bisphosphonates were clinically well tolerated.

CONCLUSIONS

The potential for gastroduodenal irritation is similar for alendronate and risedronate and is markedly less than for aspirin. The findings of this study, together with the large placebo-controlled clinical trial experience with both agents and extensive epidemiological data for alendronate, suggest that the risk for clinically important gastric irritation with these bisphosphonates is very low, even at the highest available doses.

Gender differences in osteoporosis treatment: a review of clinical research

Morbidity from osteoporosis in the aging population is substantial in both men and women; however, therapeutic options approved by the Food and Drug Administration are open only for use in women. A literature search was performed to define gender differences in pharmacologic osteoporosis treatments in published research. Only two studies on the efficacy of pharmacologic osteoporosis interventions in both genders were found, both of which involved glucocorticoid-treated patients. There is clearly a lack of information on osteoporosis treatment approaches in men compared to women, despite the increasingly recognized risk of osteoporosis in men. Although there are no approved therapies for osteoporosis in men in the United States, the scant but promising evidence suggests potential benefit from alendronate and risedronate in men as well as women. Further gender-comparative research regarding nonestrogenic approaches to osteoporosis is warranted.

[Comparative study of dimephosphon and xidiphone efficacy in steroid-induced osteoporosis in rats]

The efficacy of dimephosphon in comparison with xydiphone was studied in rats with an osteoporosis model induced by prednisolone administration at a daily dose of 50 mg/kg over a period of 14 days. The prednisolone treatment led to an increase in the content of oxyproline (a marker of bone resorption), calcium, and inorganic phosphates in the urine. Dimephosphon (monophosphate) decreased the levels of oxyproline, calcium, and inorganic phosphate in the urine. Xydiphone (biphosphonate) equally reduced the oxyproline excretion and the calcium level in urine, while rather insignificantly affecting the phosphaturia. Dimephosphon normalized the blood calcium level, while xydiphone decreased this parameter. An additional advantage of dimephosphon over xydiphone was manifested by normalization of the body weight of test rats and the total blood protein level.

[Effect of anti-osteoporosis agents on the incidence of vertebral fractures]

In the early nineties of the last century, increase in bone mineral density (BMD) was usually the primary endpoint in studies observing the effect of anti-osteoporotic medication. Recently, several large studies have been published with the number of new vertebral deformities as the primary endpoint. This should be preferred, since fractures are generally associated with clinical signs and symptoms, while changes in BMD are not. In all these studies of the effects of alendronate, risedronate, raloxiphen and calcitonin in postmenopausal women with osteoporosis there was a striking discrepancy between a small increase in BMD of the lumbar spine, varying from +2 tot +8%, and a much larger reduction in the number of patients with new vertebral fractures: -36 to -49%. This difference could be related to an effect on bone quality, an independent effect on bone resorption, or to technical limitations of BMD measurements that underestimate true effects of antiresorptive therapy. The number of patients needing to be treated to prevent one fracture depended on background risk and on the effectiveness of the therapy.

[Therapeutic strategies for osteoporosis]

Therapeutic strategy in osteoporosis should rely on the results of good quality randomized controlled trials. When a fracture has already occurred, first line treatments are alendronate or hormone replacement therapy. Alternatives are cyclical etidronate, or calcitonin in some countries. General measures, such as adequate nutrition and calcium and vitamin D intake, and prevention of falls should be associated to drugs. When there is no history of fracture, the decision will rely on the existence of clinical risk factors and the bone density. Women with a densitometric osteoporosis will be treated as those who have already fractured. Those who have osteopenia can receive hormone replacement therapy, alendronate or raloxifene. No treatment is indicated in women who have normal bone density.

Osteoporosis: which current treatments reduce fracture risk?

Randomized controlled trials showed that several antiosteoporosis drugs decrease the incidence of fractures, which is a better measure of efficacy than are changes in bone mineral density or serum markers of bone turnover. With effective agents available, physicians should make osteoporosis treatment a priority, especially for patients at high risk, such as those who have already had a fracture.

Evaluation of toxicity and efficacy of 186Re-hydroxyethylidene diphosphonate in patients with painful bone metastases of prostate or breast cancer

Twenty-eight patients (12 men with prostate cancer, 16 women with breast cancer) were included in a phase II trial to evaluate the efficacy of 186Re-hydroxyethylidene diphosphonate (HEDP) on pain from bone metastasis and the toxicity of this agent.

METHODS

After intravenous administration of 1295 MBq 186Re-HEDP, the efficacy was evaluated by means of a daily log.

RESULTS

We observed an objective response in 67% of prostate cancer patients and in 36% of breast cancer patients. The mean duration of response was 45 d for prostate cancer patients and 24 d for breast cancer patients. No major adverse effects were observed. Marrow toxicity did not exceed grade 2 for white blood cells and grade 3 for platelets using National Cancer Institute criteria.

CONCLUSION

186Re-HEDP provides safe symptomatic relief of pain in prostate cancer patients. The benefit of this treatment is less clear in breast cancer patients. Further studies should be conducted to evaluate treatment by 186Re-HEDP at an earlier stage of the disease.

Effects of risedronate treatment on bone density and vertebral fracture in patients on corticosteroid therapy

Men and women (n = 518) receiving moderate-to-high doses of corticosteroids were enrolled in two studies with similar protocols and randomly assigned to receive either placebo or risedronate (2.5 or 5 mg) for 1 year. All patients received daily calcium supplementation (500-1000 mg), and most also received supplemental vitamin D (400 IU). The primary endpoint was the difference between the placebo and active groups in lumbar spine bone mineral density (BMD) at 1 year; changes in BMD at other sites, biochemical markers of bone turnover, and the incidence of vertebral fractures were also assessed. In the overall population, the mean (SE) lumbar spine BMD increased 1.9 +/- 0.38% from baseline in the risedronate 5 mg group (P < 0.001) and decreased 1.0 +/- 0.4% in the placebo group (P = 0. 005). BMD at the femoral neck, trochanter, and distal radius increased or was maintained with risedronate 5 mg treatment, but decreased in the placebo group. Midshaft radius BMD did not change significantly in either treatment group. The difference in BMD between the risedronate 5 mg and placebo groups was significant at all skeletal sites (P < 0.05) except the midshaft radius at 1 year. The 2.5 mg dose also had a positive effect on BMD, although of a lesser magnitude than that seen with risedronate 5 mg. A significant reduction of 70% in vertebral fracture risk was observed in the risedronate 5 mg group compared with the placebo group (P = 0.01). Risedronate was efficacious in both men and women, irrespective of underlying disease and duration of corticosteroid therapy, and had a favorable safety profile, with a similar incidence of upper gastrointestinal adverse events in the placebo and active treatment groups. Daily treatment with risedronate 5 mg significantly increases BMD and decreases vertebral fracture risk in patients receiving moderate-to-high doses of corticosteroid therapy.

Timing of cyclical etidronate

OBJECTIVE

The importance of the timing of the etidronate component of cyclical etidronate was investigated in a study examining changes in lumbar spine BMD.

METHODS

Seventy patients who had been taking cyclical etidronate for at least 1 year and who had baseline BMD studies and a further scan 1 year later were mailed a questionnaire asking about the time of day they took the etidronate component. Replies were received from 52 patients who were of average age 67.5 years (SD 6) and had been on therapy for an average of 2.7 years. Patients were divided into 3 groups according to when they took etidronate: Group A--Fasting on waking, Group B--During the day, and Group C--Before retiring to bed or during the night. All patients except 2 claimed to avoid food and drink apart from water for 2 hours either side of taking etidronate.

RESULTS

The mean increases in BMD over 1 year were 3.1% group A, -0.14% Group B, and 5.4% Group C and the total change over duration of use were 5.6%, 1.2% and 7.5%, respectively. There were significant differences (P < 0.05) between group B and the other 2 groups at 1 year and over 2.7 years.

CONCLUSION

We conclude that the 2-hour rule may be insufficient for taking etidronate during the day and that the etidronate component of cyclical etidronate is best taken in the early morning or late evening/at night.

[Comparison of rhenium-188, rhenium-186-HEDP and strontium-89 in palliation of painful bone metastases]

AIM

Several radiopharmaceuticals were compared previously with regard to the efficiency in pain palliation of bone metastases. Furthermore, first results were reported on the suitability for such kind of therapy of the generator produced radionuclide rhenium-188.

METHOD

Influence of Rhenium-188-HEDP (Re-188), Rhenium-186-HEDP (Re-186) and Strontium-89 (Sr-89) on pain symptoms and bone marrow function were obtained in 44 patients (pts). These were 16 pts. with Re-188 (2943 +/- 609 MBq), 13 pts. with Re-186 (1341 +/- 161 MBq) and 15 pts. with Sr-89 (152 +/- 18 MBq) (6 woman with breast cancer and 38 men with prostata cancer).

RESULTS

81 of pts. after Re-188, 77% after Re-186 and 80% after Sr-89 reported relief of pain. The Karnofsky-Index established by pts. increased from 74 +/- 9% to 85 +/- 11% after Re-188, from 70 +/- 11% to 76 +/- 11% after Re-186 and from 62 +/- 10% to 69 +/- 10% after Sr-89. However, the difference between the pre- and the post-therapeutic value is only statistically significant in the case of Re-188 therapy (p = 0.001). A decrease of platelets of 30 +/- 14% after 2.8 +/- 0.7 for pts. treated with Re-188, of 39 +/- 20% after 3.7 +/- 1.0 weeks for pts. treated with Re-186 and of 34 +/- 26% after 4.4 +/- 1.0 weeks for pts. treated with Sr-89 compared to the value before therapy was observed. The difference was not significant between the 3 groups of pts. (p = 0.125 to 0.862).

CONCLUSION

All tried radiopharmaceuticals were effective in pain palliation. The various radionuclides had no significant difference in the pain relief or the bone marrow impairment. If only the Karnofsky-Index after Re-188 HEDP seems to be a little more increase.

Should postmenopausal women with rheumatoid arthritis who are starting corticosteroid treatment be screened for osteoporosis? A cost-effectiveness analysis

OBJECTIVE

To evaluate the cost-effectiveness of different strategies for preventing corticosteroid-induced osteoporosis.

METHODS

Simulated cohorts of postmenopausal women with rheumatoid arthritis (RA) starting corticosteroid treatment were examined. A Markov decision analysis model was developed to compare different management strategies, including watchful waiting, screen and treat, and empirical treatment. Treatment thresholds for the screen and treat strategy were varied from bone mineral density (BMD) T scores <-1.0 to BMD T scores <-4.0.

RESULTS

Compared with a watchful waiting approach, the incremental cost-effectiveness ratio for a strategy of screen and treat with alendronate at a BMD T score of <-1.0 was $92,600 per quality-adjusted life year (QALY) gained. This result was sensitive to the cost and efficacy of osteoporosis therapy and, importantly, to the treatment threshold. At a treatment threshold of a BMD T score <-2.5, the incremental cost-effectiveness ratio of screening and treating was $76,100 per QALY. None of these results differed substantially for women taking estrogen replacement therapy.

CONCLUSION

The incremental cost-effectiveness ratio of a strategy of screening and treating postmenopausal female RA patients with BMD T scores of < -1.0, compared with watchful waiting, was greater than that of other well-accepted medical interventions. The cost-effectiveness ratios were more acceptable when a T score treatment threshold of <-2.5 was used. These conclusions are limited by the lack of data on fracture and treatment efficacy in corticosteroid-treated patients.

Palliative analgesic effect of Re-186 HEDP in various cancer patients with bone metastases

The clinical picture of bone metastases is manifested by pain and loss of mechanical stability. Standard treatment options for bone metastases include external beam radiotherapy and the use of analgesics. Due to a large number of lesions in many patients, the use of radionuclide therapy with beta emitters may be preferable. Re-186 hydroxyethylidene diphosphonate (Re-186 HEDP) is one of the radiopharmaceuticals suitable for palliative treatment of metastatic bone pain. The aim of this study was to investigate palliative and side effects of Re-186 HEDP in patients with different types of cancers.

MATERIAL & METHOD

Thirty one (17 male, 14 female) patients with various cancers (10 prostate, 10 breast, 4 rectum, 5 lung, 2 nasopharynx) and bone metastases were included in the study. Therapy was started with a fixed dose of 1295 MBq of Re-186 HEDP. If necessary, the same dose was repeated at least 3 times after an interval of 10-12 weeks; A total of 40 standard doses were given; 6 patients received repeated doses (3 doses in 3 patients, 2 doses in 3 patients). The patients with bone marrow suppression were excluded from the study. The pain relief was assessed the Eastern Cooperative Oncologic Group (ECOG) and the Karnofsky status index. All patients were evaluated with standard evaluation forms filled in daily for a maximum of 10 weeks.

RESULTS

The mean response rate was 87.5% in patients with breast and prostate cancer, 75% in patients with rectum cancer and 20% in patients with lung cancer. The overall response rate was 67.5%. The palliation period varied between 6 and 10 weeks, with a mean of 8.1+/-1.3 weeks. The maximal palliation effect was observed between the 3rd and 7th weeks. No serious side effects were seen except mild hematologic toxicity.

DISCUSSION & CONCLUSION

It is concluded that Re-186 HEDP is a highly effective agent in the palliation of metastatic bone pain in patients with prostate, breast and rectum cancer, but not effective in lung cancer. On the other hand, Re-186 seems to be a good alternative to Sr-89 because of its preferable physical characteristics (such as short half life and gamma energy emission), low side effect profile, early response and repeatability.

Decrease in carotid intima-media thickness after 1-year therapy with etidronate for osteopenia associated with type 2 diabetes

It has been suggested that bisphosphonates may have some antiatherogenic actions in experimental animals or in vitro, but their effects on the atherogenic process in humans has not been reported. In the present study the effect of etidronate treatment on carotid arterial intima-media thickness was prospectively examined in 57 subjects with type 2 diabetes associated with osteopenia. After 1 yr of therapy with cyclical etidronate (200 mg/day for 2 weeks every 3 months), intima-media thickness showed a decrease (mean +/- SE, 0.038 +/- 0.011 mm), which was significantly different from a change in 57 control subjects (0.023 +/- 0.015 mm; P < 0.005). Cardiovascular parameters were not changed after etidronate treatment. These findings suggest that etidronate in clinical dosage may have an antiatherogenic action, at least in type 2 diabetes, although its mechanisms remain to be elucidated.

Quantitative bone single-photon emission computed tomography for prediction of pain relief in metastatic bone disease treated with rhenium-186 etidronate

PURPOSE

To calculate radiation doses of rhenium-186 ((186)Re) etidronate in painful bone metastases using quantitative bone single-photon emission computed tomography (SPECT) and to determine the threshold dose for predicting pain relief. We also wanted to determine whether technetium-99m ((99m)Tc) methylene diphosphonate (MDP) concentrations predict radiation doses of (186)Re etidronate in painful lesions.

MATERIALS AND METHODS

Forty-eight patients with breast and prostate cancer were evaluated. Patients received therapeutic doses of (186)Re etidronate. The area under the pain over time curve (AUPC) was measured for 8 weeks after treatment. Response was calculated as the percentage of change in AUPC. Quantitative bone SPECT (QBS)-measured concentration of (186)Re etidronate was used for calculating radiation doses. Receiver operating characteristics curve analysis determined the radiation dose threshold that best separated responders from nonresponders. SPECT-measured concentration of (186)Re etidronate in the urinary bladder was correlated with its concentration in the voided urine. Concentration of (99m)Tc MDP was compared with radiation doses to painful metastases.

RESULTS

The radiation dose threshold was 2.10 Gy. For a decrease of 50% in the AUPC, the positive predictive value (PPV) of this value was 75% and the negative predictive value (NPV) was 88%. For a decrease in pain of 33%, the PPV was 84% and the NPV was 81%. In prostate cancer patients only, the PPV was 81% and the NPV was 92%. The correlation between in vivo/in vitro measured urine concentration was 0.90. The correlation between (99m)Tc MDP concentration and radiation doses of (186)Re etidronate was 0.92.

CONCLUSION

QBS-measured radiation doses of (186)Re etidronate in painful metastases are a good predictor of pain relief. Bone SPECT using (99m)Tc MDP predicts radiation doses delivered by (186)Re etidronate.

Bisphosphonates in multiple myeloma

BACKGROUND

Myelomatosis is associated with considerable skeletal morbidity, particularly bone pain and fractures. Hypercalcaemia is a common presenting feature but less common after adequate chemotherapy. These complications are caused by progressive focal and generalized osteolysis due, in turn, to increased activation of osteoclasts by osteoclast activating factors. These include tumor necrosis factor-beta, interleukin-1, and interleukin-6. The knowledge that disturbed bone remodeling is due to the activation of authentic osteoclasts provides the rationale for the use of bisphosphonates in myelomatosis.

METHODS

This article reviews the place of bisphosphonates in the management of myeloma.

RESULTS

There is good evidence that hypercalcaemia can be corrected with intravenous or oral bisphosphonates, and they are now the specific treatment of choice. Several studies have shown that their intravenous administration is beneficial in the acute management of bone pain due to malignancy, but studies in myelomatosis are lacking. In contrast, a number of well designed controlled studies have shown significant effects of long term treatment with clodronate and pamidronate to decrease the incidence of skeletal complications in myelomatosis. Benefits reported are a decreased incidence of bone pain, hypercalcaemia, vertebral and long-bone fractures, and the extension of osteolytic lesions. There may be a beneficial effect on survival, but this is much less certain.

CONCLUSIONS

These agents provide a valuable adjunct to the management of myelomatosis.

Efficacy and safety of daily risedronate in the treatment of corticosteroid-induced osteoporosis in men and women: a randomized trial. European Corticosteroid-Induced Osteoporosis Treatment Study

Long-term use of high-dose corticosteroids often results in bone loss, which may lead to osteoporosis-related fractures. This was a multicenter, double-blind study in which 290 ambulatory men and women receiving high-dose oral corticosteroid therapy (prednisone > or = 7.5 mg/day or equivalent) for 6 or more months were randomized to receive placebo, risedronate 2.5 mg/day, or risedronate 5 mg/day for 12 months. All patients received calcium 1 g and vitamin D 400 IU daily. The primary endpoint was lumbar spine bone mineral density (BMD) at month 12. Additional measurements included BMD at the femoral neck and trochanter and the incidence of vertebral fractures. Overall, there were statistically significant treatment effects on BMD at 12 months at the lumbar spine (p < 0.001), femoral neck (p = 0.004), and trochanter (p = 0.010). Risedronate 5 mg increased BMD at 12 months by a mean (SEM) of 2.9% (0.49%) at the lumbar spine, 1.8% (0.46%) at the femoral neck, and 2.4% (0.54%) at the trochanter, whereas BMD was maintained only in the control group. Although not powered to show fracture efficacy, we observed a reduction in the incidence of vertebral fractures of 70% in the combined risedronate treatment groups, relative to placebo (p = 0.042). Risedronate was well tolerated, had a good safety profile, and was not associated with gastrointestinal adverse events. We conclude that risedronate increases BMD and potentially reduces the incidence of vertebral fractures in patients with corticosteroid-induced osteoporosis.

Rhenium-188-HEDP in the palliative treatment of bone metastases

INTRODUCTION

Rhenium-188-HEDP (188Re-HEDP) is a new and attractive radiopharmaceutical for the treatment of bone pain due to metastases. As a product of a 188W/188Re generator it is convenient for clinical use. With a short physical half life of 16.9 hours and a maximal beta-energy of 2.1 MeV, it is suitable for therapy.

METHODS

We investigated the influence of 188Re-HEDP on pain relief, analgesic intake and impairment of bone marrow function in 15 patients. All patients were interviewed using standardized questions before, and 1, 2, 3, 4, 8, and 12 weeks after therapy. Blood samples were drawn weekly for 12 weeks, and a blood count was performed. Patients underwent gamma camera imaging to determine the radionuclide accumulation 4, 20, and 28 hours after therapy. The patients were treated with 1600 to 3459 MBq of 188Re-HEDP.

RESULTS

Patients showed an improvement of the Karnofsky performance index from 74 +/- 8% to 84 +/- 11% 12 weeks after therapy. This improvement was statistically significant (p = 0.001). Eighty percent of the patients described pain relief and reduction of analgesics. Twenty percent of the patients could discontinue their analgesics. Mean platelet count decreased from (284 +/- 84)*10(3)/microliter to (205 +/- 62)*10(3)/microliter, and mean leukocyte count from (7.5 +/- 1.5)*10(3)/microliter to (5.9 +/- 2.1)*10(3)/microliter after therapy. The maximal differences between the values of platelets and leukocytes before and after therapy were not statistically significant (p = 0.021 and p = 0.094). Prostate specific antigen decreased from 95 +/- 83 ng/ml to 41 +/- 21 ng/ml, the difference was not statistically significant (p = 0.443). The bone accumulation 4, 20, and 28 hours after therapy was 1.3 +/- 0.5%, 0.6 +/- 0.3%, and 0.45 +/- 0.2% of the injected dose of a single metastasis, and 57 +/- 17%, 15.5 +/- 2% and 11 +/- 3% in the whole body, respectively. The effective half-life of 188Re-HEDP was 15.3 +/- 3.0 hours in the bone metastases, and 11.4 +/- 2.8 hours in the whole body. This corresponds to a residence time of 0.22 +/- 0.25 hours in the bone metastases, and of 10.54 +/- 2.59 hours in the whole body.

CONCLUSION

In a small patient population, 188Re-HEDP therapy for bone pain palliation was effective and was associated with minimal toxicity.

A Canadian survey on the management of corticosteroid induced osteoporosis by rheumatologists

OBJECTIVE

To survey the practice pattern of Canadian rheumatologists (CR) on their management of corticosteroid induced osteoporosis in their premenopausal (PrM) and postmenopausal (PoM) female patients.

METHODS

The practice pattern was surveyed using a 17 item questionnaire probing the diagnosis, prevention, treatment, and monitoring of osteoporosis in PrM and PoM women receiving longterm oral systemic corticosteroid therapy.

RESULTS

Most CR investigated and treated osteoporosis themselves, 13% referred to other specialists for investigation, and 22% referred for treatment. Eighty-two percent of CR used dual energy x-ray absorptiometry (DEXA) to confirm a diagnosis of osteoporosis. Most CR initiated investigation for osteoporosis at the start or within the first year of starting longterm systemic corticosteroid therapy: PrM 87% and PoM 93%. The most frequently used initial strategy for the prevention of osteoporosis was as follows. PrM: calcium and vitamin D3 (53%); PoM: hormone replacement therapy (HRT) and calcium (29%). The most common initial choice for treatment of established osteoporosis was as follows: PrM: etidronate (53%); PoM: bisphosphonates +/- HRT (53%). Ninety-six percent of CR used only bone mineral density (BMD) measurement to monitor therapy for corticosteroid induced osteoporosis. Most CR monitored BMD every 12 to 24 months for PrM (81%) and PoM (84%). The BMD parameter(s) (T and Z scores as measured by DEXA) used to initiate therapy for corticosteroid induced osteoporosis was variable.

CONCLUSION

It appears that, while certain trends are evident, there is still considerable variability in the management of corticosteroid induced osteoporosis.