REVIEW - The pathogenesis, epidemiology and management of steroid-induced osteoporosis

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Calcif Tissue Int. 2006 Sep;79(3):129-37. Epub 2006 Sep 11.

The pathogenesis, epidemiology and management of glucocorticoid-induced

osteoporosis.

Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht,

The Netherlands.

Oral glucocorticoids (GCs) are frequently used in the treatment of

inflammatory conditions, such as rheumatoid arthritis or asthma. They have

adverse skeletal effects, primarily through reductions in bone formation and

osteocyte apoptosis. Several findings indicate that changes in the quality

of bone may significantly contribute to the increased risk of fracture and

that loss of BMD only partially explains the increased risk of fracture in

oral GC users. Epidemiological studies have found that the increases in the

risk of fracture in oral GC users are dose dependent and occur within three

months of starting GC therapy. Daily doses of >2.5 mg prednisone equivalent

have been associated with increases in the risk of fractures and randomised

studies reported adverse skeletal effects with daily doses as low as 5 mg.

After discontinuation of GC treatment, the risk of fracture may reduce

towards baseline levels unless patients previously used high cumulative

doses of oral GCs. Users of inhaled GCs have also an increased risk of

fracture, especially at higher doses. But it is likely that this excess risk

is related to the severity of the underlying respiratory disease, rather

than to the inhaled GC therapy. It has been recommended that patients who

start on oral GC therapy should receive calcium and vitamin D

supplementation. Patients with a higher risk of fracture should also receive

a bisphosphonate.

PMID: 16969593

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=16969593

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