II. Pathophysiology

  1. Bone density decreases the most in the first 3-6 months of oral steroid use

III. Risk Factors: Osteoporosis on long-term Corticosteroids

  1. More than 10% of those on chronic steroids will have a steroid-induced osteoporotic Fracture
  2. Prednisone 1-5 mg: Relative Risk 1.9x
  3. Prednisone 5-10 mg: Relative Risk 4.5x
  4. Prednisone >10 mg: Relative Risk 32x

IV. Imaging: DEXA Scan (Bone Mineral Density)

  1. Indications
    1. Men or women over age 50 years old AND
    2. Chronic Corticosteroid use (Prednisone >5 mg/day) for >3 months OR
    3. Three or more steroid bursts over a 6 month period
    4. Also, consider other Osteoporosis Risk Factors
  2. Protocol
    1. Check BMD at baseline prior to therapy
    2. Check BMD every 6-12 months during first 2 years

V. Prevention: Osteoporosis from long-term steroids

  1. Use lowest dose of a short-acting glucocorticoid
  2. Maintain a well-balanced, low Sodium diet (2-3 gram)
  3. Weight bearing Exercise and Isometric Exercise
  4. Calcium Supplementation 1000-1200 mg/day
  5. Vitamin D Supplementation 600-800 IU/day
  6. Control Hypercalciuria with Thiazide Diuretics
  7. Reduce other Osteoporosis Risk Factors
    1. Tobacco Cessation
    2. Limit Alcohol
    3. Adequate nutrition
  8. Treat Hypogonadism
    1. Menopause: Hormone Replacement Therapy
    2. Men with low testosterone: Testosterone Replacement
  9. Treat bone loss if it occurs with Corticosteroid use
    1. See Osteoporosis Management for indications
    2. Hormone Replacement Therapy
    3. Bisphosphonates
    4. Calcitonin

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