S21_14

Fluoride in the prevention and treatment of glucocorticoid-induced osteoporosis

W.F. Lems¹, J.W.G. Jacobs², J.W.J. Bijlsma²

¹Academic Hospital Vrije Universiteit, Slotervaart Hospital, Jan van Breemen Institute, Amsterdam; ²University Medical Center, Utrecht, The Netherlands.

ABSTRACT
Since the use of fluoride has been shown to stimulate bone formation and since decreased bone formation is a key feature in the pathogenesis of corticosteroid-induced osteoporosis (CIOP), fluoride is, at least theoretically, attractive for the prevention and treatment of CIOP.
In postmenopausal women positive effects of low-dose fluoride on the bone mineral density (BMD) of the lumbar spine and on the vertebral fracture rate were found; in contrast, in patients treated with high dose fluoride, an increase in the peripheral fracture rate was found.
Randomized controlled trials of the effects of fluoride in Cs-treated patients are scarce. Although positive effects of low-dose fluoride on BMD of the lumbar spine have been observed, fluoride does not represent the first choice therapy for the prevention or treatment of CIOP, because no positive effects on BMD of the hips and (so far) no reduction in the vertebral fracture rate have been shown.

Key words
Fluoride, osteoporosis, glucocorticoids.

Please address correspondence and reprint requests to: W.F. Lems, Academic Hospital Vrije Universiteit, Department of Rheumatology (B417), PO Box 7057, 1007 MB Amsterdam, The Netherlands.
E-mail: wf.lems@azvu.nl