Skip to main content
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2005 Feb;64(2):176–178. doi: 10.1136/ard.2003.018556

How to prevent steroid induced osteoporosis

P Sambrook 1
PMCID: PMC1755379  PMID: 15647424

Full Text

The Full Text of this article is available as a PDF (174.0 KB).

Figure 1.

Figure 1

 The degree of bone loss due to corticosteroids varies according to dose, underlying disease and, possibly, genetic factors. The case for intervention is strong (primary prevention) in postmenopausal women but is less clear in premenopausal women. As fracture risk is a function of time receiving corticosteroids, it is appropriate to consider secondary prevention in pre- and postmenopausal women receiving long term CS who have low BMD. Reproduced with permission from Sambrook PN, Corticosteroid osteoporosis: practical implications of recent trials. J Bone Min Res 2000;15:1645–9.

Figure 2.

Figure 2

 Management algorithm for glucocorticoid osteoporosis.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adachi J. D., Bensen W. G., Bianchi F., Cividino A., Pillersdorf S., Sebaldt R. J., Tugwell P., Gordon M., Steele M., Webber C. Vitamin D and calcium in the prevention of corticosteroid induced osteoporosis: a 3 year followup. J Rheumatol. 1996 Jun;23(6):995–1000. [PubMed] [Google Scholar]
  2. Amin Shreyasee, Lavalley Michael P., Simms Robert W., Felson David T. The comparative efficacy of drug therapies used for the management of corticosteroid-induced osteoporosis: a meta-regression. J Bone Miner Res. 2002 Aug;17(8):1512–1526. doi: 10.1359/jbmr.2002.17.8.1512. [DOI] [PubMed] [Google Scholar]
  3. Buckley L. M., Leib E. S., Cartularo K. S., Vacek P. M., Cooper S. M. Calcium and vitamin D3 supplementation prevents bone loss in the spine secondary to low-dose corticosteroids in patients with rheumatoid arthritis. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 1996 Dec 15;125(12):961–968. doi: 10.7326/0003-4819-125-12-199612150-00004. [DOI] [PubMed] [Google Scholar]
  4. Eastell R., Reid D. M., Compston J., Cooper C., Fogelman I., Francis R. M., Hosking D. J., Purdie D. W., Ralston S. H., Reeve J. A UK Consensus Group on management of glucocorticoid-induced osteoporosis: an update. J Intern Med. 1998 Oct;244(4):271–292. doi: 10.1046/j.1365-2796.1998.00408.x. [DOI] [PubMed] [Google Scholar]
  5. Lane N. E., Sanchez S., Modin G. W., Genant H. K., Pierini E., Arnaud C. D. Parathyroid hormone treatment can reverse corticosteroid-induced osteoporosis. Results of a randomized controlled clinical trial. J Clin Invest. 1998 Oct 15;102(8):1627–1633. doi: 10.1172/JCI3914. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Reid I. R., Wattie D. J., Evans M. C., Stapleton J. P. Testosterone therapy in glucocorticoid-treated men. Arch Intern Med. 1996 Jun 10;156(11):1173–1177. [PubMed] [Google Scholar]
  7. Richy Florent, Ethgen Olivier, Bruyere Olivier, Reginster Jean-Yves. Efficacy of alphacalcidol and calcitriol in primary and corticosteroid-induced osteoporosis: a meta-analysis of their effects on bone mineral density and fracture rate. Osteoporos Int. 2004 Jan 22;15(4):301–310. doi: 10.1007/s00198-003-1570-5. [DOI] [PubMed] [Google Scholar]
  8. Saag K. G., Emkey R., Schnitzer T. J., Brown J. P., Hawkins F., Goemaere S., Thamsborg G., Liberman U. A., Delmas P. D., Malice M. P. Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis. Glucocorticoid-Induced Osteoporosis Intervention Study Group. N Engl J Med. 1998 Jul 30;339(5):292–299. doi: 10.1056/NEJM199807303390502. [DOI] [PubMed] [Google Scholar]
  9. Sambrook Philip N., Kotowicz Mark, Nash Peter, Styles Colin B., Naganathan Vasi, Henderson-Briffa Kathy N., Eisman John A., Nicholson Geoff C. Prevention and treatment of glucocorticoid-induced osteoporosis: a comparison of calcitriol, vitamin D plus calcium, and alendronate plus calcium. J Bone Miner Res. 2003 May;18(5):919–924. doi: 10.1359/jbmr.2003.18.5.919. [DOI] [PubMed] [Google Scholar]
  10. Selby P. L., Halsey J. P., Adams K. R., Klimiuk P., Knight S. M., Pal B., Stewart I. M., Swinson D. R. Corticosteroids do not alter the threshold for vertebral fracture. J Bone Miner Res. 2000 May;15(5):952–956. doi: 10.1359/jbmr.2000.15.5.952. [DOI] [PubMed] [Google Scholar]
  11. Van Staa T. P., Laan R. F., Barton I. P., Cohen S., Reid D. M., Cooper C. Bone density threshold and other predictors of vertebral fracture in patients receiving oral glucocorticoid therapy. Arthritis Rheum. 2003 Nov;48(11):3224–3229. doi: 10.1002/art.11283. [DOI] [PubMed] [Google Scholar]
  12. Van Staa T. P., Leufkens H. G., Abenhaim L., Zhang B., Cooper C. Use of oral corticosteroids and risk of fractures. J Bone Miner Res. 2000 Jun;15(6):993–1000. doi: 10.1359/jbmr.2000.15.6.993. [DOI] [PubMed] [Google Scholar]
  13. Wallach S., Cohen S., Reid D. M., Hughes R. A., Hosking D. J., Laan R. F., Doherty S. M., Maricic M., Rosen C., Brown J. Effects of risedronate treatment on bone density and vertebral fracture in patients on corticosteroid therapy. Calcif Tissue Int. 2000 Oct;67(4):277–285. doi: 10.1007/s002230001146. [DOI] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES