[Medical prophylaxis and treatment of steroid induced osteoporosis].
BACKGROUND
Glucocorticoid steroids are widely used as antiinflammatory and immunosuppressive medications and are well known to induce osteoporosis.


METHODS
Randomised clinical trials and Cochrane reports on the use of calcium, vitamin D, bisphosphonates and hormones were reviewed and the results summarised. Additionally, national and some international recommendations were reviewed in order to propose recommendations for prophylaxis and treatment. The literature was identified by Medline searches.


CONCLUSIONS
Calcium and vitamin D prevent bone loss in low-to-medium-dose glucocorticoid steroid therapy. Bisphosphonates maintain or modestly increase lumbar and hip bone mass. The fracture risk was not significantly reduced in the spine and the hip. The clinical randomised trials and Cochrane reports conclude that bisphosphonates as well as calcium and vitamin D taken together are effective and the drugs of choice in prevention and treatment.
Klinikk for ortopedi og revmatologi, Revmatologisk avdeling, St. Olavs Hospital, 7006 Trondheim. erik.rodevand@Stolav.no
Erik
E
Rødevand
Knut
K
Mikkelsen
Bjørn-Yngvar
BY
Nordvåg
Hans-Jacob
HJ
Haga
Øystein
Ø
Førre
Villy
V
Johnsen
Tore Kristian
TK
Kvien
D015519:Bone Density / Q000187:drug effects; D002116:Calcitonin / Q000008:administration & dosage; D002118:Calcium / Q000008:administration & dosage; D004164:Diphosphonates / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000139:chemically induced* / Q000188:drug therapy / Q000517:prevention & control; D010281:Parathyroid Hormone / Q000008:administration & dosage; D017410:Practice Guidelines as Topic; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D014807:Vitamin D / Q000008:administration & dosage
D004164:Diphosphonates; D005938:Glucocorticoids; D010281:Parathyroid Hormone; D014807:Vitamin D; D002116:Calcitonin; D011239:Prednisolone; D002118:Calcium