Management of steroid-induced osteoporosis.
OBJECTIVE
To review the pathogenesis, clinical presentation, diagnostic assessment and treatment regimens of steroid-induced bone loss.


METHODS
An English-language literature search (MEDLINE 1966-1999) and bibliographic reviews of textbooks and review articles.


METHODS
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.


CONCLUSIONS
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.
Lambrinoudaki
I
I
Department of Medicine, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
Kung
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AW
D000465:Algorithms; D015519:Bone Density; D001842:Bone and Bones / Q000187:drug effects; D002118:Calcium / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D006801:Humans; D010024:Osteoporosis / Q000139:chemically induced* / Q000517:prevention & control; D012307:Risk Factors; D013256:Steroids / Q000009:adverse effects*; D014807:Vitamin D / Q000008:administration & dosage
D013256:Steroids; D014807:Vitamin D; D002118:Calcium