[Corticosteroid osteoporosis in the adult]

EARLY BONE LOSS: Bone loss is greatest in patients given supra-physiological doses of corticosteroids during the first months of treatment. The rate of loss then tapers off but persists throughout the duration of the treatment because of depressed osteoblast activity.

Corticosteroid-induced osteoporosis is a multifactorial phenomenon depending in part on the duration and the dose of the treatment and in part on prior bone status and the causal disease. Young subjects can expect to recover bone mass partially or completely after withdrawal. Menopaused women not taking hormone replacement therapy have a low bone mass and are high risk patients.

Preventive measures against corticosteroid-induced osteoporosis should begin with treatment onset. Patients should be given calcium and vitamin D supplements, hormone replacement therapy (menopaused women) or androgens (hypogonadic men), and biphosphonates (for young patients at risk or in case of bone mass despite the preceding measures).