Recommendations for the Prevention and Treatment of Steroid-Induced Osteoporosis

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Arthritis & RheumatismOfficial Journal of the American College of RheumatologyVolume 39, No. 11, November 1996, pp 1791-1801Excerpt:It is generally accepted that moderate-to-high-dose glucocorticoid therapyis associated with loss of bone and increased risk of fracture. Skeletalwasting is most rapid during the first 6 months of therapy; trabecular boneis affected to a greater degree than cortical bone. The skeletal effects ofglucocorticoids appear to be both dose and duration dependent, with dailyprednisone doses of [lte]7.5 mg often resulting in significant bone loss andincreased fracture risk (17-24). The cumulative dose also affects theseverity of bone loss. It is not known whether there is a threshold dose ofglucocorticoid below which osteopenia does not occur; alternate-dayglucocorticoid regimens, however, have not been shown to produce less boneloss than daily regimens (25,26). Even inhaled steroids have been shown toincrease bone loss (27-29).The magnitude of this problem has been demonstrated by cross-sectionalstudies, which suggest that the majority of patients receiving long-termglucocorticoid therapy have low bone mineral density, and that overone-fourth sustain osteoporotic fractures. The prevalence of vertebralfractures in asthma patients receiving steroid therapy for at least 1 yearis 11% (17), and steroid-treated patients with rheumatoid arthritis have anincreased incidence of fractures of the hip, rib, spine, leg, ankle, andfoot (20-22). Thus, glucocorticoid-induced osteoporosis is an importantclinical problem which commands the physician's attention to both preventionand treatment.http://www.rheumatology.org/publications/guidelines/osteo/osteo.asp?aud=mem