Corticosteroid-induced osteoporosis

The pathogenesis, prevention, and treatment of corticosteroid-induced osteoporosis are reviewed. Prolonged administration of corticosteroids causes osteoporosis, resulting in significant morbidity and mortality. Cumulative corticosteroid doses greater than 10 g, age greater than 50 years, and pre-existing low bone mass are risk factors for corticosteroid-induced osteoporosis. Long-term, prospective, controlled studies on prevention and treatment of corticosteroid-induced osteoporosis are limited. Measures for preventing corticosteroid-induced osteoporosis include correcting modifiable risk factors and using the lowest effective oral or inhaled corticosteroid dose for the shortest period of time. Routine use of fluoride, anabolic steroids, vitamin D, thiazide diuretics, injected calcitonin, or calcium supplements alone is not recommended. Intranasal calcitonin and pamidronate are possibilities for future treatment of corticosteroid-induced osteoporosis. Estrogen replacement therapy should be considered in postmenopausal women receiving corticosteroids. Deflazacort, a new synthetic corticosteroid, may provide a promising alternative to existing systemic corticosteroid therapy. More long-term, controlled, prospective trials are needed to determine the effectiveness of treatments for corticosteroid-induced osteoporosis and to develop improved methods for monitoring response to therapy.