Corticosteroid-Induced
Osteoporosis
Corticosteroids such as prednisone or methylprednisolone are valuable, commonly prescribed
medications utilized in the treatment of many diseases, including, rheumatic, respiratory
and intestinal ailments. CIO (also referred to as steroid or glucocorticosteroid-induced
osteoporosis) is the most common form of drug-induced osteoporosis. It typically develops
when corticosteroids are taken for prolonged periods of time. The higher the dose and
longer the duration of treatment with corticosteroids, the greater the risk of developing
osteoporosis and fractures.
Cause of Corticosteroid-Induced Osteoporosis
The production of strong healthy bone is dependent on a balance between the factors that
stimulate bone growth versus those that break down bone. In CIO, the forces favoring the
break down of bone outweigh those of bone formation that leads, in turn, to osteoporosis.
In addition, corticosteroids can decrease the absorption of calcium from the intestine.
Diagnosis of Corticosteroid-Induced Osteoporosis
The use of DEXA remains the best tool to measure bone density. Because bone loss occurs
rapidly after starting corticosteroids, the American College of Rheumatology's Task Force
on Osteoporosis has recommended obtaining a DEXA at the start of treatment with
corticosteroids. This test should be rechecked one year after initiating corticosteroids
treatment to determine if clinically significant changes in bone density have developed.
Treatment of Corticosteroid-Induced
Osteoporosis
The therapeutic options listed for osteoporosis similarly apply to CIO. Using the lowest
possible dose of corticosteroids for the briefest period of time or, when medically
indicated, switching to a non- corticosteroids drug is advised. However, it is important
to remember that the pre-treatment identification of persons at risk of CIO remains one of
the most important weapons to combat CIO. People with low bone mass at the start of
corticosteroid treatment, such as post-menopausal women who have not taken estrogen and
the elderly, are at highest risk of sustaining a fracture; men and pre-menopausal women
are also at risk.
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