Glucocorticoid-induced osteoporosis evaluation, prevention, and treatment

Systemically administered glucocorticoids are widely used in rheumatology and have many serious side effects. Approximately 30-50% of patients chronically taking glucocorticoids develop osteoporosis. Studies looking at specific rheumatologic diseases, such as rheumatoid arthritis, suggest that subpopulations of rheumatology patients are particularly at risk for development of osteoporosis.Over the last few years, several studies have validated the role of routine administration of calcium and low dose vitamin D. Early limited studies suggest that hormonal replacement of testosterone and estrogen in selected patients may be of value, and newer therapies such as bisphosphonates and calcitonin have revolutionized the prevention and treatment of steroid-induced osteoporosis. These newer therapies, combined with the increased availability and accuracy of tests that measure bone mineral density, such as dual energy x-ray absorptiometry (DXA), make it important to use such tests and to individualize needed interventions for all patients requiring long-term systemic gluocorticoids.