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CME Information
Introduction
Pathophysiology of Glucocorticoid-Induced Osteoporosis
Inhaled Corticosteroids
V.	Evaluation of The Patient
VI.	Secondary Causes of Osteoporosis
Management
Summary
Self-Assessment
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  References

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1. Buckley LM, Marquez M, Hudson JO, et al. Variations in physicians' judgments about corticosteroid induced osteoporosis by physician specialty. J Rheumatol. 1998;25:2195-2202.

2. Adler RA, Hochberg MC. Suggested guidelines for evaluation and treatment of glucocorticoid-induced osteoporosis for the Department of Veterans Affairs. Arch Intern Med. 2003;163:2619-2624.

3. van Staa TP, Leufkens HG, Cooper C. Use of inhaled corticosteroids and risk of fractures. J Bone Miner Res. 2001;16:581-588.

4. Lukert BP, Raisz LG. Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Intern Med. 1990;112:352-364.

5. Adinoff AD, Hollister JR. Steroid-induced fractures and bone loss in patients with asthma. N Engl J Med. 1983;309:265-268.

6. van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C.Use of oral corticosteroids and risk of fractures. J Bone Miner Res. 2000; 15: 993-1000.

7. Canalis E. Mechanisms of glucocorticoid action in bone; implications to glucocorticoid induced osteoporosis. J Clin Endocrinol Metab. 1996;81:3441-3447.

8. Lukert BP, Raisz LG. Glucocorticoid-induced osteoporosis. Rheum Dis Clin North Am. 1994;20:629-650.

9. Canalis E, Bilezikian JP, Angeli A, Giustina A. Perspectives on glucocorticoid-induced osteoporosis. Bone 2004; 34:593-598

10. Lipworth BJ. Systemic adverse effects of inhaled corticosteroid therapy: A systematic review and meta-analysis. Arch Intern Med. 1999;159:941-955.

11. Sorkness CA. Establishing a therapeutic index for the inhaled corticosteroids: part II. Comparisons of systemic activity and safety among different inhaled corticosteroids. J Allergy Clin Immunol. 1998;102:S52-64.

12. Li JT, Ford LB, Chervinsky P, et al. Fluticasone propionate powder and lack of clinically significant effects on hypothalamic-pituitary-adrenal axis and bone mineral density over 2 years in adults with mild asthma. J Allergy Clin Immunol. 1999;103:1062-1068.

13. Allen HD, Thong IG, Clifton-Bligh P, Holmes S, Nery L, Wilson KB. Effects of high-dose inhaled corticosteroids on bone metabolism in prepubertal children with asthma. Pediatr Pulmonol. 2000;29:188-193.

14. Harris M, Hauser S, Nguyen TV, et al. Bone mineral density in prepubertal asthmatics receiving corticosteroid treatment. J Paediatr Child Health. 2001;37:67-71.

15. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 update. American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis. Arthritis Rheum. 2001;44:1496-1503.

16. Bone health and osteoporosis: A report of the Surgeon General.Rockville, MD: U.S. Department of Health and Human Services; 2004 http://www.surgeongeneral.gov/library/bonehealth/

17. Physician’s Guide to Prevention and Treatment of Osteoporosis. 2nd ed. Washington, DC: National Osteoporosis Foundation; 2003 http://www.nof.org.

18. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum. 1996;39:1791-1801.

19. Gluck OS, Murphy WA, Hahn TJ, Hahn B. Bone loss in adults receiving alternate day glucocorticoid therapy. Arth Rheum. 1981;24:892-898.

20. Saag KG. Low-dose corticosteroid therapy in rheumatoid arthritis: balancing the evidence. Am J Med. 1997;103:31S-39S.

21. Saag KG, Koehnke R, Caldwell JR, et al. Low dose long-term corticosteroid therapy in rheumatoid arthritis: an analysis of serious adverse events. Am J Med. 1994;96:115-123.

22. Adachi JD, Saag KG, Delmas PD, et al. Two-year effects of alendronate on bone mineral density and vertebral fracture in patients receiving glucocorticoids: a randomized, double-blind, placebo-controlled extension trial. Arthritis Rheum. 2001;44:202-211.

23. Wallach S, Cohen S, Reid DM, et al. Effects of risedronate treatment on bone density and vertebral fracture in patients on corticosteroid therapy. Calcif Tissue Int. 2000;67:277-285.

24. Reid DM, Hughes RA, Laan RF, et al. 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. J Bone Miner Res. 2000;15:1006-1013.

25. Cohen S, Levy RM, Keller M, et al. Risedronate therapy prevents corticosteroid-induced bone loss: a twelve-month, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Arthritis Rheum. 1999;42:2309-2318.

26. Lane NE, Sanchez S, Modin GW, Genant HK, Pierini E, Arnaud CD. Bone mass continues to increase at the hip after parathyroid hormone treatment is discontinued in glucocorticoid-induced osteoporosis: results of a randomized controlled clinical trial. J Bone Miner Res. 2000;15:944-951.

27. Adachi JD, Bensen WG, Bell MJ, et al. Salmon calcitonin nasal spray in the prevention of corticosteroid-induced osteoporosis. Br J Rheumatol. 1997;36:255-259.

28. Healey JH, Paget SA, Williams-Russo P, et al. A randomized controlled trial of salmon calcitonin to prevent bone loss in corticosteroid-treated temporal arteritis and polymyalgia rheumatica. Calcif Tissue Int. 1996;58:73-80.

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