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Related Experiment Videos

Bone densitometry, steroids and osteoporosis.

Glen M Blake1, Ignac Fogelman

  • 1Department of Nuclear Medicine, Guy's Hospital, London, UK. glen.blake@kcl.ac.uk

Current Opinion in Nephrology and Hypertension
|October 24, 2002
PubMed
Summary

Oral corticosteroid use increases fracture risk. Guidelines now recommend earlier intervention for corticosteroid-induced osteoporosis, using a higher threshold for bone mineral density scans.

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Area of Science:

  • Endocrinology
  • Rheumatology
  • Geriatrics

Background:

  • Oral corticosteroid use is a significant risk factor for fragility fractures, particularly affecting the spine and hip.
  • Existing guidelines address the investigation and management of corticosteroid-induced osteoporosis.

Purpose of the Study:

  • To review the role of bone mineral density (BMD) scans in evaluating patients at risk of osteoporosis.
  • To discuss current guidelines for managing corticosteroid-induced osteoporosis.

Main Methods:

  • Review of large trials on fracture prevention agents (bisphosphonates, SERMs, parathyroid hormone).
  • Analysis of diagnostic criteria and treatment thresholds for osteoporosis.

Main Results:

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  • A consensus exists on using a T-score of -2.5 or lower for osteoporosis diagnosis in postmenopausal women.
  • Separate studies have evaluated fracture prevention in postmenopausal osteoporosis and corticosteroid-induced osteoporosis.

    • Conclusions:

    • Increased awareness of the need for preventive treatment in patients on high-dose oral corticosteroids (≥7.5 mg prednisolone daily).
    • Corticosteroid use is an independent fracture risk factor.
    • Intervention thresholds for bone-sparing treatment are higher for corticosteroid-induced osteoporosis (T-score -1.5) compared to general osteoporosis (T-score -2.5).