Conclusion
With the relatively poor documentation of the effectiveness of interventions in steroid osteoporosis conclusions regarding optimal management remain tentative. It seems sensible to measure bone density in all individuals who appear likely to be on long-term steroid therapy. In those judged to be at risk of fractures on the basis of this measurement, the institution of some prophylactic regimen is advisable. Calcium supplements, thiazide diuretics and, where appropriate, sex hormone replacement therapy are suitable first-line agents. In those with established osteoporosis and in those showing continuing deterioration in bone mineral density in spite of these interventions, the use of other agents discussed may be indicated. In the future, the availability of second-generation bisphosphonates in an oral formulation may make the prevention and treatment of this condition much more straightforward.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Reid IR. Pathogenesis and treatment of steroid osteoporosis. Clin Endocrinol 1989;30:83–103.
Lukert BP, Raisz LG. Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Intern Med 1990;112:352–64.
Adinoff AD, Hollister JR. Steroid-induced fractures and bone loss in patients with asthma. N Engl J Med 1983;309:265–8.
Cooper C, Wickham C. Rheumatoid arthritis, corticosteroid therapy and fracture of the proximal femur [abstract]. J Bone Miner Res 1990 [Supp12]:S109.
Reid IR, Evans MC, Wattie DJ, Ames R, Cundy TF. Bone mineral density of the proximal femur and lumbar spine in glucocorticoid-treated asthmatic patients. Osteoporosis Int (in press).
Reid IR, Heap SW. Determinants of vertebral mineral density in patients receiving chronic glucocorticoid therapy. Arch Intern Med 1990;150:2545–8.
Lowe C, Gray DH, Reid IR. Serum blocks the osteolytic effect of cortisol in neonatal mouse calvaria. Calcif Tissue Int (in press).
Reid IR, France JT, Pybus J, Ibbertson HK. Low plasma testosterone levels in glucocorticoid-treated male asthmatics. BMJ 1985;291:574.
Manning PJ, Evans MC, Reid IR. Normal bone mineral density following cure of Cushing's syndrome. Clin Endocrinol (in press).
Adachi JD, Bensen WG, Bell MJ, Cividino A, Stolar M, Craig GL, et al. A randomized double blind placebo controlled trial of vitamin D and calcium in the prevention of corticosteroid induced bone loss [abstract]. J Bone Miner Res 1989;4[Suppl 1]:S233.
Di Munno O, Beghe F, Favini P, Di Giuseppe P, Pontrandolfo A, Occhipinti G, Pasero G. Prevention of glucocorticoid-induced osteopenia: effect of oral 25-dihydroxyvitamin D and calcium. Clin Rheumatol 1989;8:202–7.
Bayley TA, Muller C, Harrison J, Basualdo J, Sturtridge W, Josse R, et al. The long-term treatment of steroid osteoporosis with fluoride. J Bone Miner Res 1990;5[Suppl 1]:S157-S161.
Reid IR, King AR, Alexander CJ, Ibbertson HK. Prevention of steroid-induced osteoporosis with (3-amino-1-hydroxypropylidene)-1,1-bisphosphonate (ADP). Lancet 1988;1:143–6.
Reid IR, Heap SW, King AR, Ibbertson HK. Two-year follow-up of bisphosphonate (ADP) treatment in steroid induced osteoporosis [letter]. Lancet 1988;2:1144.
Reid IR, Schooler BA, Stewart AW. Biochemical effects of oral bisphosphonate therapy for the prevention of glucocorticoid-induced osteoporosis. J Bone Miner Res 1990;5:619–23.
Ringe JD, Welzel D. Salmon calcitonin in the therapy of corticoid-induced osteoporosis. Eur J Clin Pharmacol 1987;33(1):35–9.
Need AG. Corticosteroids and osteoporosis. Aust NZ J Med 1987;17:267–72.
Grecu EO, Weinshelbaum A, Simmons R. Effective therapy of glucocorticoid-induced osteoporosis with medroxyprogesterone acetate. Calcif Tissue Int 1990;46:294–9.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Reid, I.R. Steroid osteoporosis. Osteoporosis Int 3 (Suppl 1), 144–146 (1993). https://doi.org/10.1007/BF01621890
Issue Date:
DOI: https://doi.org/10.1007/BF01621890