Corticosteroid Osteoporosis

  • Philip N. Sambrook


  • Corticosteroids are used widely in the treatment of patients with chronic inflammatory diseases. Since the most rapid bone loss occurs in the first 12–24 months after commencing high-dose corticosteroids, it is important to consider two different therapeutic situations: (i) prevention in patients starting corticosteroids and (ii) treatment of patients on chronic corticosteroids who will already have some significant degree of corticosteroid-related bone loss.

  • An adequate calcium intake is recommended, and any contributing factors to osteoporosis should be treated.

  • Bone density will give information about the future risk of osteoporotic fracture and the need for active pharmacologic treatment.

  • Patients commencing high-dose long-term corticosteroid therapy (>10 mg/day prednisone for more than four months) should be treated prophylactically with a bisphosphonate: treatment may have to be continued for one to two years.

  • Alternate or adjunctive therapy to bisphosphonates includes vitamin D metabolites and HRT (Figure 21.1).

  • The evidence from randomized, controlled trials and other studies suggests that postmenopausal women receiving corticosteroids are at the greatest risk of rapid bone loss and consequent vertebral fracture and should be considered most actively for prophylactic measures (Figure 21.2).

  • In men and premenopausal women receiving corticosteroids, the decision to use anti-osteoporosis prophylaxis will depend on a number of factors, including baseline BMD and anticipated dose and duration of corticosteroids.

  • It is important in a patient on long-term corticosteroid therapy to review the need for continuing treatment or the possibility of dosage reduction. Since fracture risk is a function of multiple factors, including the severity of low bone density as well as the duration of exposure, treatment to increase bone density will reduce the risk of fracture in patients receiving chronic, low-dose glucocorticoids.


Lumbar Spine Bone Loss Vertebral Fracture Salmon Calcitonin Rapid Bone Loss 
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Further Reading


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© Springer-Verlag London 2004

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  • Philip N. Sambrook

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