Corticosteroid-induced osteoporosis

Since Harvey Cushing first noted the coexistence of excess cortisol and los s of skeletal mass over 50 years ago, it has been accepted that supraphysio logic doses of corticosteroids cause clinically significant bone loss. Curr ently, high-dose oral corticosteroids are used to treat people with a varie ty of medical conditions, including: rheumatic diseases, such as rheumatoid arthritis, polymyalgia rheumatica, systemic lupus erythematosus and vascul itis; inflammatory lung diseases, like asthma; gastrointestinal diseases, s uch as inflammatory bowel disease and chronic liver disease; skin diseases, in particular pemphigus, and more recently those who have undergone transp lantation. Clinically significant bone loss occurs in the vast majority of patients exposed to corticosteroids, and fractures at the spine and hip hav e been reported with corticosteroid use. Between 30 and 50 percent of patie nts taking long-term corticosteroids will experience fractures. Today, fractures due to corticosteroid-induced osteoporosis may be prevente d. A number of well-designed randomized controlled trials have been conduct ed that demonstrate preservation and, in some instances, actual increases i n bone mass with the use of appropriate drug treatment. Some have even demo nstrated reductions in fracture risk. As a result, it is extremely importan t for clinicians to appreciate the very high risk for vertebral fracture, p articularly in postmenopausal women on corticosteroids.