Steroid-induced Osteoporosis

Ewa Sewerynek; Michal Stuss


Aging Health. 2012;8(5):471-477. 

In This Article

Personal Approach & Experiences

Our approach to steroid-induced osteoporosis is similar to ACR recommendations. In our opinion, there is no safe dose of steroids, so it is crucial that patients receive the lowest dose possible. In our clinical practice, we take into account the absolute risk of fracture, which is also affected by other factors apart from steroid therapy, such as previous osteoporotic fractures in the patient and his family (especially hip fractures), low BMI, low calcium intake, age >65 years of life in women and >70 years in men, smoking, hypogonadism and other disorders that can cause secondary osteoporosis, and of course, a disease that is the cause of chronic steroid use. The results of biochemical tests and imaging are also very important. Low BMD and abnormal bone resorption markers concentrations often indicate an antiresorptive treatment (high levels of bone resorption markers, such as C-terminal telopeptide of collagen type 1: CTX) or stimulating bone formation agents (low levels of bone formation markers, such as osteocalcin, bone alkaline phosphatase fraction) should be used. We should start the treatment of osteoporosis from the compensation of calcium and vitamin D3 deficiencies. The most common form of therapy in our everyday practice is orally given and in rare cases, intravenously-administered bisphosphonates. The native parathyroid hormone or teriparatide are undoubtly valuable therapeutic options, but in Poland they are very rarely used, due to the high price. In patients with hypogonadism or in postmenopausal women with menopausal symptoms a hormone replacement therapy may be considered. We are monitoring BMD of the hip and lumbar spine, initially every 12 months (more often in patients with high bone turnover), and thereafter every 2 years. The patients treated with calcium supplements and native vitamin D3 should be monitored with calcium and 25-hydroxyvitamin D3 concentrations in serum and urinary calcium excretion. In addition, in case of patients receiving vitamin D derivatives, such as alphacalcidiol, the above biochemical studies should be mandatory. Bone turnover marker concentrations should be checked after 3 months of therapy as the assessment of response to treatment. In our center, at the every visit the patient's height is measured. When the total height reduction is above 4 cm, or a 1 cm decrease occurs between visits, we should consider an x-ray of the spine or at least densitometric Vertebral Fracture Assessment.