Intended for healthcare professionals


Prevention of corticosteroid induced osteoporosis

BMJ 1999; 318 doi: (Published 22 May 1999) Cite this as: BMJ 1999;318:1366

Should be easier if doctors follow the recent guidelines

  1. Paul Lips, Internist (
  1. Department of Endocrinology, Academic Hospital Vrije Universiteit, PO Box 7057, 1007 MB Amsterdam, Netherlands

    Corticosteroid induced osteoporosis has presented a challenge to clinicians for many years. Bone loss during corticosteroid treatment is mediated by inhibition of gonadal and adrenal steroid production, leading to hypogonadism and a direct negative effect on calcium absorption and osteoblast function.1 Epidemiological data suggest that corticosteroid treatment doubles the risk of fractures of the hip and distal radius and at least quadruples the risk of vertebral fracture. How can this damage be limited?

    Corticosteroids are widely used, especially for rheumatoid arthritis, polymyalgia rheumatica, and chronic obstructive pulmonary disease. A cross sectional study in Nottinghamshire in over 65 000 patients showed that 0.5% were taking oral corticosteroids.2 Most were aged 60-80 years and the mean dose was 8 mg/day, with a median duration of treatment of three years. Only 14% of these patients had received preventive treatment for osteoporosis. If these data are extrapolated to the whole population, over 250 000 people in the United Kingdom are taking oral corticosteroids.

    Monitoring bone loss has become easy now that bone mineral density can be measured with dual energy x ray absorptiometry. Nevertheless, many patients taking long term corticosteroids are not referred for bone mineral density …

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