Preventive therapy for steroid-induced osteoporosis in interstitial lung disease

We do not have to accept bone loss and high fracture rates as inevitable consequences of high-dose glucocorticoid therapy. The assessment of the risk of osteoporosis should be an integral part of the decision to commence glucocorticoid therapy. The decision to initiate a preventive strategy should be taken on the basis of the expected risk of developing osteoporosis. This risk should be evaluated on the basis of the expected duration of corticosteroid therapy, the needed dose, the drug given, and the presence of risk factors. Pro and cons of calcium, vitamin D, inhibitors of bone resorption, stimulators of bone formation, and thiazide diuretics are described in the light of the presence of an interstitial lung disease.