Endocrinology Book

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Corticosteroid Associated Osteoporosis

Aka: Corticosteroid Associated Osteoporosis, Osteoporosis Secondary to Corticosteroid Use, Steroid-Related Bone Mineral Density Loss, Glucocorticoid Induced Osteoporosis
  1. See Also
    1. Systemic Corticosteroid
    2. Osteoporosis
  2. Pathophysiology
    1. Bone density decreases the most in the first 3-6 months of oral steroid use
  3. 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
  4. 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
  5. 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
  6. References
    1. (2018) Presc Lett 25(11): 62-3
    2. Dubois (2002) Chest 121:1456-63 [PubMed]
    3. Lane (1998) Endocrinol Metab Clin North Am 27:465-83 [PubMed]

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