Corticosteroid-Induced Osteoporosis: A Comprehensive Review

It has been accepted that supraphysiologic doses of corticosteroids cause clinically significant bone loss. Clinically significant bone loss occurs in most men and women exposed to corticosteroids. Between 30% and 50% of patients taking long-term corticosteroids experience fractures. With more elderly patients being treated with corticosteroids for a variety of illnesses, the prevalence of corticosteroid-induced osteoporosis, fractures, and associated morbidity and mortality can only increase unless aggressive intervention is undertaken. If corticosteroids must be used, then one would hope to be able to prevent fractures by using agents that achieve rapid response and stabilize bone mass. In individuals who are at particular risk for osteoporotic fractures, that risk may be reducedby using the lowest effective corticosteroid dose and using preventive agents such as the bisphosphonates at the time corticosteroids are instituted. In those requiting treatment, the bisphosphonates remain the treatment of choice. Vitamin D is a valuable adjunct to the bisphosphonates. Hormone replacement therapy for postmenopausal women and calcitonin are alternatives to bisphosphonate-intolerant persons. Adequate intake of calcium and an exercise program might also be beneficial but it need to be used in conjunction with other therapy. © 2004 Elsevier Inc. All rights reserved.