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.

van Staa TP.

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/pubmed/16969593

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