[Glucocorticoid-induced osteoporosis]

Osteoporosis due to steroid therapy is one of the most frequent and serious adverse events of antirheumatic therapy. The greatest loss of bone occurs during the 1st year of steroid intake, with the largest loss in the spine. Up to 50% of the patients, mostly postmenopausal women, suffer vertebral fractures. The prevalence of osteoporosis in 60-year-old patients with rheumatoid arthritis (RA) is more than double compared to the normal population. There are more risk factors other than age, gender, and menopause. Independent from the underlying disease, glucocorticoid therapy is associated with a high risk of osteoporosis development. Among the clinical manifestations of osteoporosis, fractures of the vertebrae, hips, and ribs are the most common. In clinical practice, bone density measurements are mostly performed with the dual-energy X-ray absorptiometry (DXA) technique. Since prevalent vertebral fractures are strongly predictive of new fractures, X-rays of the lumbar and thoracic spine are indicated in patients who are scheduled to receive steroid therapy for > 3 months. The value of serologic bone markers has not yet been clearly established. On the basis of these risks and the high prevalence of already manifest osteoporosis, there is a clear indication for osteoprotective therapy in RA. Bisphosphonates and active vitamin D metabolites play an important role for therapy and prophylaxis of steroid-induced osteoporosis. In rheumatology it is often necessary to administer bisphosphonates intravenously due to the disability of the patients. The clear necessity for prophylaxis and therapy of steroid-induced osteoporosis must be stressed. Efforts should be intensified to ensure even more consistent application in daily practice. Doctors should treat their steroid patients on the basis of the clear-cut indications for intervention despite budget problems.