Prevention and treatment of corticosteroid-induced osteoporosis in the elderly

Corticosteroid-induced osteoporosis is a serious complication of corticosteroid therapy. Bone loss occurs within the first three to six months of corticosteroid use. Fracture rates can be quite high within the first year of corticosteroid therapy. All patients on or starting corticosteroids need to have assessments for secondary causes of osteoporosis, counseling for modification of risk factors, and measures taken to prevent fractures. All patients should have a calcium intake of 1200-1500 mg per day and vitamin D supplementation of 800-1000 IU per day. Bisphosphonates are currently the most potent antiresorptive agent. This class of medication has also been shown to reduce the occurrence of vertebral fractures. Bisphosphonate therapy is the recommended first-line agent both for the prevention and treatment of corticosteroid-induced osteoporosis.