How effective is risedronate in preventing bone loss in patients on high-dose steroids?

Abstract

Oral bisphosphonates have proven to be an effective strategy for the prevention and treatment of glucocorticoid-induced osteoporosis; however, information on the efficacy of these agents in patients receiving high-dose glucocorticoid therapy is scarce. In this Practice Point commentary, we discuss the 6-month, randomized, placebo-controlled study of Mok et al., which evaluated the efficacy of 5 mg oral risedronate daily for the prevention of bone loss at the spine and hip in patients receiving high-dose prednisolone therapy (>0.5 mg/kg/day). Risedronate prevented bone loss at the spine and attenuated, but did not prevent, bone loss at the hip. We compare and contrast the findings of Mok et al. with previously published studies of bisphosphonate therapy in glucocorticoid-induced osteoporosis, taking into account the pathophysiology of this condition, and highlight gaps in our knowledge and in current patient care.