Corticosteroid osteoporosis

Corticosteroids are widely used and effective agents for the control of man y inflammatory diseases, but corticosteroid osteoporosis is a common proble m associated with their long term high dose use. Prevention of corticostero id osteoporosis is preferable to treatment of established corticosteroid bo ne loss. Several large double-blind controlled clinical trials in patients with cort icosteroid osteoporosis have recently been published that provide new insig hts into its treatment. Based upon available evidence, the rank order of ch oice for prophylaxis would be a bisphosphonate followed by a vitamin D meta bolite or an oestrogen type medication. Calcium alone appears to be unable to prevent rapid bone loss in patients starting corticosteroids, especially with prednisolone doses at 10 mg a day or greater. If an active vitamin D metabolite is used, calcium supplementation should be avoided unless dietar y calcium intake is low. Hormone replacement therapy should be considered i f hypogonadism is present. Since vertebral fracture is a common and importa nt complication of high dose corticosteroid therapy, these findings suggest that rapid bone loss and hence fractures, can be prevented by prophylactic treatment. Although the follow-up data is limited, it is likely that such therapy needs to be continued beyond 12 months whilst patients continue sig nificant doses of corticosteroid therapy.