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Updated: Sep 30, 2026

Tension-Free Weight-Bearing Model of Steroid-Induced Osteonecrosis of Femoral Head in Rats
Published on: September 27, 2024
Glucocorticoid osteoporosis
1Institute of Bone & Joint Research, University of Sydney, Sydney, Australia. mchurchi@doh.health.nsw.gov.au
Abstract:
Postmenopausal women are at greatest risk of rapid bone loss and fracture with glucocorticoids and should be actively considered for prophylactic measures. In men and premenopausal women receiving glucocorticoids, the decision to use anti-osteoporosis prophylaxis is less clear and depends upon baseline bone mineral density [BMD], anticipated dose and duration of glucocorticoids. Based upon evidence the order of choice for prophylaxis would be a bisphosphonate followed by a vitamin D metabolite or hormone replacement therapy [HRT]. Calcium alone appears unable to prevent rapid bone loss in patients starting glucocorticoids. HRT should clearly be considered if hypogonadism is present. In patients receiving chronic low dose glucocorticoids, treatment with calcium and vitamin D may be sufficient to prevent further bone loss. However since fracture risk is a function of multiple factors including the degree of reduction in BMD as well as the duration of exposure, treatment with therapy to increase BMD will reduce fracture risk even in patients receiving chronic low dose glucocorticoids.
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