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Corticosteroid osteoporosis.

P Sambrook1, N E Lane

  • 1Institute of Bone and Joint Research, University of Sydney, Sydney, Australia.

Best Practice & Research. Clinical Rheumatology
|August 4, 2001
PubMed
Summary
This summary is machine-generated.

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Preventing corticosteroid-induced osteoporosis is crucial. Bisphosphonates are recommended first-line prophylaxis, followed by vitamin D or estrogen, to avert bone loss and fractures from long-term steroid use.

Area of Science:

  • Endocrinology
  • Rheumatology
  • Osteoporosis Research

Background:

  • Corticosteroids are vital for inflammatory diseases but cause significant bone loss (osteoporosis) with long-term, high-dose use.
  • Preventing corticosteroid-induced osteoporosis is more effective than treating established bone loss.
  • Recent clinical trials offer new insights into managing this condition.

Purpose of the Study:

  • To review current evidence on the prevention and treatment of corticosteroid-induced osteoporosis.
  • To establish a rank order for prophylactic treatments.
  • To inform clinical practice regarding bone protection during corticosteroid therapy.

Main Methods:

  • Analysis of recent large, double-blind, controlled clinical trials.
  • Evaluation of prophylactic agents including bisphosphonates, vitamin D metabolites, and estrogen-type medications.

Related Experiment Videos

  • Assessment of calcium supplementation and hormone replacement therapy efficacy.

    • Main Results:

    • Bisphosphonates are the preferred first-line prophylaxis for corticosteroid osteoporosis.
    • Vitamin D metabolites or estrogen-type medications are second-line options.
    • Calcium alone is insufficient for preventing bone loss at prednisolone doses ≥10 mg/day; active vitamin D requires monitoring calcium intake.

    Conclusions:

    • Prophylactic treatment, particularly with bisphosphonates, can effectively prevent rapid bone loss and vertebral fractures associated with high-dose corticosteroid therapy.
    • Continued prophylactic therapy is likely necessary for at least 12 months during significant corticosteroid treatment.
    • Hormone replacement therapy should be considered in cases of hypogonadism.