Common Questions
What are detailed prevention guidelines and rationale for corticosteroid induced osteoporosis?
Guidelines suggest that all patients beginning corticosteroid therapy with prednisone equivalent of 5 mg per day, with plans for treatment > 3 months, should be evaluated and treated for prevention of osteoporosis (1-6). Therapies to prevent or treat corticosteroid-induced bone loss should be continued as long as the patient is receiving corticosteroids (4).
| Recommendation | Rationale |
|---|---|
| Calcium intake of 1000 mg per day in premenopausal women, 1500 mg per day in women and men over age 50 (1-7) | Compensate for hypercalciuria, impaired absorption and inadequate dietary intake |
| Vitamin D intake of 800-1,000 IU per day | Compensate for decreased absorption, low vitamin D skin synthesis and low dietary intake |
| Encourage good general nutrition (1-5,7) | Maintain adequate body mass index |
| Use the lowest effective dose of corticosteroid, substituting inhaled or topical preparations when possible (1-7) | Effects of corticosteroids on bone are dose relate |
| Encourage weight-bearing exercise for 30-60 minutes per day (1-7) | Reduce bone resorption, preserve muscle mass, improves mobility, agility, and gait stability |
| Patient education about steroids, osteoporosis, and fall prevention (1-7) | Prevent falls by improving home safety and educating patients about their risks |
| Limit alcohol (2-5,7) | Reduce modifiable risk factors for osteoporosis, reduce risk of falls |
| Smoking cessation (1-5,7) | Reduce modifiable risk factors |
| Physical therapy balance and gait assessment (2-6) | Improve balance and posture training, reduce risk of future falls, and evaluate for possible assistive devices |
- Hodgson SF, Watts NB, Bilezikian JP, Clarke BL, Gray TK, Harris DW, Johnston CC, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: 2001 edition, with selected updates for 2003. Endocr Pract 2003; 9;6: 544-564.
- Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of osteoporosis. Institute for Clinical Systems Improvement (ICSI) 0000; Bloomingto.
- National Osteoporosis Society. Guidelines on glucocorticoid-induced osteoporosis. 2002. Available online.
- American College of Rheumatology. Recommendations for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. Arthritis and Rheumatism 2001; 44;7: 1496-1503.
- Yeap SS, Hosking DJ. Management of corticosteroid-induced osteoporosis.. Rheumatology 2002; 41: 1088-1094.
- Adler RA, Hochberg MC. Suggested guidelines for evaluation and treatment of glucocorticoid-induced osteoporosis for the Department of Veterans Affairs. Archives of Internal Medicine 2003; 163: 2619-2623.
- American Gastroenterological Association. American Gastroenterological Association Medical Position Statement: Guidelines on osteoporosis in gastrointestinal diseases. Gastroenterology 2003; 124;3: 791-794.