Steroid-induced osteoporosis

Steroid-induced osteoporosis is osteoporosis arising due to use of glucocorticoids (steroid hormones) - analogous to Cushing's syndrome and involving mainly the axial skeleton. The synthetic glucocorticoid prescription drug prednisone is a main candidate after prolonged intake. Bisphosphonates are beneficial in reducing the risk of vertebral fractures.[1] Some professional guidelines recommend prophylactic calcium and vitamin D supplementation in patients who take the equivalent of more than 30 mg hydrocortisone (7.5 mg of prednisolone), especially when this is in excess of three months.[2][3] The use of thiazide diuretics, and gonadal hormone replacement has also been recommended, with the use of calcitonin, bisphosphonates, sodium fluoride or anabolic steroids also suggested in refractory cases.[4] Alternate day use may not prevent this complication.[5]

Steroid-induced osteoporosis
Other namesSIOP

Mechanism

Mechanisms of SIOP include:[6]

  • Direct inhibition of osteoblast function
  • Direct enhancement of bone resorption
  • Inhibition of gastrointestinal calcium absorption
  • Increased urine calcium loss
  • Inhibition of sex steroids

Diagnosis

The diagnosis of osteoporosis can be made using conventional radiography and by measuring the bone mineral density (BMD). The most popular method of measuring BMD is Dual-energy X-ray absorptiometry.

In addition to the detection of abnormal BMD, the diagnosis of osteoporosis requires investigations into potentially modifiable underlying causes; this may be done with blood tests. Depending on the likelihood of an underlying problem, investigations for cancer with metastasis to the bone, multiple myeloma, Cushing's disease and other above-mentioned causes may be performed.

References
  1. Allen CS, Yeung JH, Vandermeer B, Homik J (October 2016). "Bisphosphonates for steroid-induced osteoporosis". The Cochrane Database of Systematic Reviews. 10: CD001347. doi:10.1002/14651858.CD001347.pub2. PMC 6461188. PMID 27706804.
  2. Bone and Tooth Society of Great Britain, National Osteoporosis Society, Royal College of Physicians (2003). Glucocorticoid-induced Osteoporosis (PDF). London, UK: Royal College of Physicians of London. ISBN 978-1-86016-173-5.CS1 maint: multiple names: authors list (link)
  3. Homik J, Suarez-Almazor ME, Shea B, Cranney A, Wells G, Tugwell P (2000). "Calcium and vitamin D for corticosteroid-induced osteoporosis". The Cochrane Database of Systematic Reviews (2): CD000952. doi:10.1002/14651858.CD000952. PMC 7046131. PMID 10796394.
  4. Lukert BP, Raisz LG (March 1990). "Glucocorticoid-induced osteoporosis: pathogenesis and management". Annals of Internal Medicine. 112 (5): 352–64. doi:10.7326/0003-4819-112-5-352. PMID 2407167.
  5. Gourlay M, Franceschini N, Sheyn Y (February 2007). "Prevention and treatment strategies for glucocorticoid-induced osteoporotic fractures". Clinical Rheumatology. 26 (2): 144–53. doi:10.1007/s10067-006-0315-1. PMID 16670825.
  6. Steroid-induced osteoporosis By Susan Ott, MD. Updated January 28, 2009. Retrieved on 26 March 2009
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