Steroid-induced osteoporosis: Pathogenesis and therapeutic consequences

Many chronic inflammatory diseases require treatment with steroids, however , a remarkable proportion of steroid-treated patients suffer from osteoporo sis as major complication after longterm treatment. Steroid-induced osteopo rosis represents one of the most important secondary causes of osteoporosis . The pathogenesis is complex, there exists evidence that steroids cause a reduction of circulating testosteron and estrogen concentration and adverse ly affect calcium balance. The most important mechanism is a decrease in os teoblastic activity. As a consequence loss of bone mineral density and incr eased risk of fracture develop. In spite of better understanding of the cau sal relationships preventive strategies were infrequently applied. If we care for patients with steroid therapy we have both to consider the p roblem of steroid-induced osteoporosis and to focus on strategies to evalua te patients at risk. The dosage of the steroid, life style factors (such as lack of exercise, alcohol consumption and smoking), menopausal status, low bone mineral density at baseline and previous osteoporotic fractures predi spose for the manifestation of steroid-induced osteoporosis. Therapeutic de cisions depend on risk factors of the individual patient. Supplementation o f calcium and vitamin D is usually appropriate, and postmenopausal women sh ould be offered hormon replacement therapy. The prescription of bisphosphon ates is strongly recommended to patients at elevated risk.