Management of steroid-induced osteoporosis

PURPOSE: To review the pathogenesis, clinical presentation, diagnostic assessment and treatment regimens of steroid-induced bone loss. DATA SOURCES: An English-language literature search (MEDLINE 1966-1999) and bibliographic reviews of textbooks and review articles. STUDY SELECTION: Cross-sectional and prospective studies with BMD measurements or fracture rate. RESULTS: The greatest rate of bone loss occur during the first 6 to 12 months of steroid therapy, affecting trabecular more than cortical bone. High steroid dosage for a prolonged period, prevalent fracture, hypogonadism, older age, low calcium intake and family history of osteoporosis are risk factors for steroid-induced bone loss. Based on bone density results, patients with osteoporosis or osteopenia with a T-score below -1.5 should receive antiresorptive treatment during steroid therapy. Among the various antiresorptive agents, bisphosphonates have the strongest evidence of preventing steroid-induced bone loss. CONCLUSION: The most important step in the management of steroid-induced osteoporosis is the proper assessment of the individual patient's risk of bone loss, and the selection of appropriate anti-resorptive agent for each patient.