II. Pathophysiology
- Bone density decreases the most in the first 3-6 months of oral steroid use
III. Risk Factors: Osteoporosis on long-term Corticosteroids
- More than 10% of those on chronic steroids will have a steroid-induced osteoporotic Fracture
- Prednisone 1-5 mg: Relative Risk 1.9x
- Prednisone 5-10 mg: Relative Risk 4.5x
- Prednisone >10 mg: Relative Risk 32x
IV. Imaging: DEXA Scan (Bone Mineral Density)
- Indications
- Men or women over age 50 years old AND
- Chronic Corticosteroid use (Prednisone >5 mg/day) for >3 months OR
- Three or more steroid bursts over a 6 month period
- Also, consider other Osteoporosis Risk Factors
- Protocol
- Check BMD at baseline prior to therapy
- Check BMD every 6-12 months during first 2 years
V. Prevention: Osteoporosis from long-term steroids
- Use lowest dose of a short-acting Glucocorticoid
- Maintain a well-balanced, Low Sodium Diet (2-3 gram)
- Weight bearing Exercise and Isometric Exercise
- Calcium Supplementation 1000-1200 mg/day
- Vitamin D Supplementation 600-800 IU/day (15-20 mcg/day)
- Control Hypercalciuria with Thiazide Diuretics
- Reduce other Osteoporosis Risk Factors
- Tobacco Cessation
- Limit Alcohol
- Adequate nutrition
- Treat Hypogonadism
- Treat bone loss if it occurs with Corticosteroid use
- See Osteoporosis Management for indications
- Hormone Replacement Therapy
- Bisphosphonates
- Calcitonin
VI. References
- (2018) Presc Lett 25(11): 62-3
- Dubois (2002) Chest 121:1456-63 [PubMed]
- Lane (1998) Endocrinol Metab Clin North Am 27:465-83 [PubMed]