Bisphosphonates in the treatment of glucocorticoid-induced osteoporosis

Hypovitaminosis D and the endocrine phenotype of COVID-19

BACKGROUND

Vitamin D and its deficiency have recently been suspected to be involved in increased susceptibility and negative outcomes of COVID-19. This assumption was based on the well known immunomodulatory actions of vitamin D and on the consistent finding of low levels of 25 hydroxyvitamin D (25OHD) in hospitalized patients with COVID-19. Moreover, several studies reported a correlation between 25OHD levels and different clinical outcomes of the disease.

AIM

Aim of the current review was to approach the topic of vitamin D and COVID-19 from a different perspective summarizing the data which led to the evidence of the existence of an endocrine phenotype of COVID-19.

CONCLUSIONS

This review analyzed in the light of the current knowledge the possibility that several endocrine manifestations of COVID-19 could be holistically interpreted in the context of an inadequate vitamin D status.

Treatment of glucocorticoid-induced osteoporsis

Glucocorticoid-induced osteoporosis (GIO) is the most common form of secondary osteoporosis. Fractures occur in 30-50% of patients with GIO. Therefore, treatment of this disease is critical. Although patients should receive supplemental calcium and vitamin D, additional measures are necessary to prevent fractures. Estrogens and androgens may be of value in patients with hypogonadism, but bisphosphonates and teriparatide are the most effective agents in the treatment of GIO. Bisphosphonates prevent the early bone loss that follows exposure to glucocorticoids, and which has been attributed to increased resorption. Teriparatide appears to be more effective than alendronate in established GIO when reduced bone formation is the predominant pathophysiological mechanism. In conclusion, GIO can be prevented and treated with appropriate medical intervention.