[Steroid induced osteoporosis: prevention and treatment].
OBJECTIVE
Corticosteroid induced osteoporosis (CIO) is the most frequent complication of long-term corticosteroid therapy, and the most frequent cause of secondary osteoporosis. New data from biological, epidemiological and therapeutic studies provide basis for optimal management of this bone disease.


RESULTS
Corticosteroids are responsible for both quantitative and qualitative deleterious effects on bone, through their effect on bone cells, mainly on osteoblasts (with both a decrease in osteoblast activity and an increase in apoptosis). Epidemiological studies have shown an increased risk of fractures related to CIO, even for low doses, and during the first 6 months of treatment. Relative risk is 1.3 and 2.6 for peripheral and vertebral fractures respectively. Bone mineral density, measured by dual-energy X-ray absorptiometry, is decreased at spine and hip; the risk of fracture is higher in CIO as compared to post-menopausal osteoporosis, for a similar bone density. Prevention of CIO needs the use of the minimal efficacious dose, and treatment of calcium, vitamin D and gonadal hormones insufficiencies. Patients at risk of fracture, as post-menopausal women with prevalent fractures, should receive a bisphosphonate.


CONCLUSIONS
It may be possible to reduce the fracture risk in patients on long-term corticosteroid therapy.
Roux
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C
Institut de rhumatologie, hôpital Cochin, centre d'évaluation des maladies osseuses, 27, rue du Faubourg-Saint-Jacques, 75014, Paris, France. christian.roux@cch.ap-hop-paris.fr <christian.roux@cch.ap-hop-paris.fr>
Orcel
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P
D015502:Absorptiometry, Photon; D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D015519:Bone Density; D006801:Humans; D010024:Osteoporosis / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*
D000305:Adrenal Cortex Hormones