[Risk of osteoporosis in steroid therapy. When and how to counter the risk]

Many chronic inflammatory diseases require treatment with steroids, however, a remarkable proportion of steroid-treated patients suffer from osteoporosis as a major complication following longterm treatment. Steroid-induced osteoporosis with its complex pathogenesis represents one of the most important secondary causes of osteoporosis. If we care for patients with steroid therapy we have both to consider this problem and to focus on strategies to evaluate patients at risk. The dosage of the steroid, life style factors, menopausal status, low bone mineral density at baseline and previous osteoporotic fractures predispose for the manifestation of steroid-induced osteoporosis. Decisions in regard of prevention and therapy depend on risk factors of the individual patient. Supplementation of calcium and vitamin D is usually appropriate, and postmenopausal women should be offered hormone replacement therapy. The prescription of bisphosphonates is strongly recommended to patients at elevated risk or to patients with already documented osteoporosis.