Bisphosphonate use for glucocorticoid-induced osteoporosis in older patients with immune thrombocytopenia: a clinical perspective

Prednisolone, used as a standard initial treatment for immune thrombocytopenia (ITP), is an important risk factor for osteoporosis. Recently, we found that prescription of bisphosphonate during initial loading of prednisolone may prevent reduction in bone mineral density and development of glucocort...

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Bibliographic Details
Published in:Annals of hematology 2023-07, Vol.102 (7), p.1645-1656
Main Author: Yamasaki, Satoshi
Format: Article
Language:English
Subjects:
Bisphosphonates
Blood platelets
Bone density
Disease prevention
Fractures
Hematology
Immunoglobulins
Infections
Medicine
Medicine & Public Health
Oncology
Osteoporosis
Response rates
Review
Review Article
Risk factors
Steroids
Thrombocytopenia
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Summary:Prednisolone, used as a standard initial treatment for immune thrombocytopenia (ITP), is an important risk factor for osteoporosis. Recently, we found that prescription of bisphosphonate during initial loading of prednisolone may prevent reduction in bone mineral density and development of glucocorticoid-induced osteoporosis (GIO) in older patients with ITP receiving prolonged steroid therapy. In this review, I describe the treatment options for older patients with ITP, and present the best practices for screening, evaluating, and diagnosing ITP. I also summarize the literature from 2017 to 2022 on the treatment options for ITP, including discussions on the contraindications and side effects, with an emphasis on GIO, and the relative merits of bisphosphonates as a co-treatment for prevention of GIO. Finally, I present a perspective and an expert recommendation on how older patients with ITP would best be served in the future.
ISSN:0939-5555
1432-0584
DOI:10.1007/s00277-023-05266-7