title: Bone densitometry, steroids and osteoporosis.
abstract: OBJECTIVE
  Scans to measure bone mineral density at the spine and hip have an important role in the evaluation of patients at risk of osteoporosis. Oral corticosteroid use is an important risk factor for a fragility fracture and the relative risk is particularly high for vertebral and hip fractures. In Europe and the USA, guidelines have been published for the investigation of patients at risk of corticosteroid-induced osteoporosis, with recommendations on the diagnostic use of bone mineral density scans and the initiation of treatment based on the findings.
  
  
  RESULTS
  Large trials of bisphosphonates, selective oestrogen receptor modulators and parathyroid hormone have addressed the issue of fracture prevention in women with postmenopausal osteoporosis and there is a growing consensus that the World Health Organization definition of osteoporosis of a -score=-2.5 is an appropriate threshold for preventive treatment in these patients. For most agents separate studies have been conducted of their use for the prevention and treatment of corticosteroid-induced osteoporosis.
  
  
  CONCLUSIONS
  There is increased awareness of the importance of preventive treatment for osteoporosis in patients taking high doses of oral corticosteroids (daily dose of 7.5 mg prednisolone or greater). In view of evidence that corticosteroid use is an independent risk factor for fracture over and above bone mineral density, guidelines for intervention set a higher threshold than the World Health Organization figure ( -score=-1.5 rather than -2.5) for intervention with bone sparing treatment in these patients.
authors.affiliation: Department of Nuclear Medicine, Guy's Hospital, London, UK. glen.blake@kcl.ac.uk
authors.forename: Glen M
authors.initials: GM
authors.lastname: Blake
authors.forename: Ignac
authors.initials: I
authors.lastname: Fogelman
mesh_terms: D000368:Aged; D015519:Bone Density / Q000502:physiology*; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control; D017408:Guidelines as Topic; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D013256:Steroids / Q000009:adverse effects*; D009626:Terminology as Topic
chemical_list: D013256:Steroids