Modern approaches to the prevention and treatment of glucocorticoid-induced osteoporosis

Protsenko G.O.¹, Afanasieva I.O.², Nemish I.L.³

• ¹SU «National Scientific Center «Institute of Cardiology, Clinical and Regenerative Medicine named after Academician M.D. Strazhesko of the National Academy of Medical Sciences of Ukraine», Kyiv
• ²Bogomolets National Medical University
• ³Bukovinian State Medical University

Summary. Glucocorticoid (GC)-induced osteoporosis is one of the most common complications of long-term GC therapy, characterized by decreased bone mineral density and a high risk of fragility fractures. Based on the analysis of current clinical guidelines, considering the situation in Ukraine and clinical pharmacology data, we propose a practical approach that may be useful for physicians in the prevention and treatment of GC-induced osteoporosis. The proposed strategy includes optimization of GC dosage with maintenance of the minimally effective therapeutic level, lifestyle modification (regular physical activity, smoking cessation, reduction of excessive alcohol intake), nutritional support, as well as pharmacotherapy tailored to the individual fracture risk. An important component of this strategy is the use of combined preparations such as Osteocitrat and Osteocitrat MAX, which contain calcium, magnesium, and zinc in citrate form, along with vitamin D3 and vitamin K2. Calcium citrate has the highest bioavailability among calcium salts and is well absorbed regardless of food intake or gastric acidity. Vitamin D3 promotes optimal calcium absorption, while vitamin K2 ensures its effective incorporation into bone tissue and prevents vascular calcification. Magnesium supports bone structure and neuromuscular function, whereas zinc stimulates bone formation and mineralization. Due to the synergistic action of these components, the use of the preparation contributes to increased bone strength and prevention of osteoporotic fractures, without increasing the risk of kidney stones or vascular calcification. Thus, the use of Osteocitrat or Osteocitrat MAX, in combination with lifestyle modification and modern pharmacotherapy, represents the most effective strategy for reducing the risk of osteoporotic fractures in patients receiving long-term GC therapy.