Corticosteroid-induced osteoporosis: a guide to optimum management

Treat Endocrinol. 2002;1(5):271-9. doi: 10.2165/00024677-200201050-00001.

Abstract

Corticosteroid-induced osteoporosis is the leading cause of secondary osteoporosis and a significant cause of morbidity in both men and women. Long-term use of even low-dose corticosteroids has been associated with increased risk of bone loss. Recent large randomized controlled trials have generated new knowledge on treatment strategies for patients with corticosteroid-induced osteoporosis. However, the majority of individuals receiving corticosteroids are not receiving prophylaxis for osteoporosis. Calcium and vitamin D should be recommended to patients initiating therapy with corticosteroids (and should be adequate for those receiving corticosteroids for less than 3 months). For those receiving corticosteroids for greater than 3 months, bisphosphonates are the therapy of choice, with both alendronate (alendronic acid) and risedronate (risedronic acid) approved by the US FDA for use in this indication. Calcitonin can be considered a second-line agent and should be reserved for patients who are intolerant of bisphosphonates or who are experiencing pain from a vertebral fracture. Hormone replacement therapy or testosterone therapy may be offered to those individuals on long-term corticosteroid treatment who are hypogonadal. Teriparatide (recombinant human parathyroid hormone 1-34) shows promise as a future anabolic agent for the prevention and treatment of patients with corticosteroid-induced osteoporosis.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adrenal Cortex Hormones / adverse effects*
  • Calcium / therapeutic use*
  • Diphosphonates / therapeutic use
  • Humans
  • Osteoporosis / chemically induced*
  • Osteoporosis / drug therapy*
  • Practice Guidelines as Topic
  • Vitamin D / therapeutic use

Substances

  • Adrenal Cortex Hormones
  • Diphosphonates
  • Vitamin D
  • Calcium