INFO - Recommendations for the Prevention and Treatment of Steroid-Induced Osteoporosis

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Arthritis & Rheumatism

Official Journal of the American College of Rheumatology

Volume 39, No. 11, November 1996, pp 1791-1801

Excerpt:

It is generally accepted that moderate-to-high-dose glucocorticoid therapy

is associated with loss of bone and increased risk of fracture. Skeletal

wasting is most rapid during the first 6 months of therapy; trabecular bone

is affected to a greater degree than cortical bone. The skeletal effects of

glucocorticoids appear to be both dose and duration dependent, with daily

prednisone doses of [lte]7.5 mg often resulting in significant bone loss and

increased fracture risk (17-24). The cumulative dose also affects the

severity of bone loss. It is not known whether there is a threshold dose of

glucocorticoid below which osteopenia does not occur; alternate-day

glucocorticoid regimens, however, have not been shown to produce less bone

loss than daily regimens (25,26). Even inhaled steroids have been shown to

increase bone loss (27-29).

The magnitude of this problem has been demonstrated by cross-sectional

studies, which suggest that the majority of patients receiving long-term

glucocorticoid therapy have low bone mineral density, and that over

one-fourth sustain osteoporotic fractures. The prevalence of vertebral

fractures in asthma patients receiving steroid therapy for at least 1 year

is 11% (17), and steroid-treated patients with rheumatoid arthritis have an

increased incidence of fractures of the hip, rib, spine, leg, ankle, and

foot (20-22). Thus, glucocorticoid-induced osteoporosis is an important

clinical problem which commands the physician's attention to both prevention

and treatment.

http://www.rheumatology.org/publications/guidelines/osteo/osteo.asp?aud=mem

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