OsteoEd

Practice Cases

Corticosteroid-Induced Osteoporosis

Mara Lang, MD Literature reviewed July 31, 2006. Updated June 02, 2009

A 63-year-old woman with hypertension presents to your office with severe weakness and pain in her shoulders and thighs. She's barely able to get out of the chair due to pain and weakness. Her erythrocyte sedimentation rate is elevated and you diagnose her with polymyalgia rheumatica. You plan to start her on prednisone therapy to treat her PMR.

  • Past Medical History:
    • Hypertension
    • Hypothyroidism
    • Menopause age 52
  • Medications:
    • Levo-thyroxine 125 mcg PO daily
    • Hydrochlorothiazide 25 mg PO daily
    • Atenolol 50 mg PO daily
    • Aspirin 81 mg PO daily
    • Prednisone 10mg PO daily - starting today

Click an answer under each question.

  1. Which medicines can increase the risk of osteoporosis?

  2. How does the corticosteroid dose affect her risk of osteoporosis?

    • Option A Prednisone doses less than 10mg per day are physiologic and pose no increased risk of osteoporosis
    • Option B The dose of prednisone is not important unless she takes it for greater than 6 months
    • Option C Decreased bone density occurs with doses of prednisone as low as 2.5mg daily
    • Option D Switching to an alternate-day dosing regimen would eliminate the risk of osteoporosis

  3. Your patient's DXA shows a T score of -2.0 at the hip, -1.8 at the spine. How would you monitor bone mineral density in this patient?

    • Option A No bone mineral density monitoring is necessary as long as she continues to take calcium and vitamin D
    • Option B DXA in 6 to 12 months
    • Option C DXA in 1 to 2 years
    • Option D DXA in 2 to 3 years

  4. Which medication would you recommend to prevent bone loss?

  5. You plan to start her on alendronate and lower the prednisone dose each month. Which of the following should you also do?

    • Option A Recommend weight-bearing exercise
    • Option B Encourage dietary supplementation with vitamin D and calcium
    • Option C Counsel your patient on smoking cessation
    • Option D All of the above

  6. What class of anti-hypertensive might also reduce osteoporosis risk in this patient?

Key Points
Last edited July 03, 2009