The incidence of osteoporosis in patients receiving long-term glucocorticoid therapy is 30% to 50%. Trabecular bone is lost more rapidly than cortical. The cause of glucocorticoid-induced bone loss is multifactorial. Gastrointestinal absorption of calcium falls and urinary excretion rises, production of gonadal hormones decreases, and bone formation is inhibited in the presence of glucocorticoids. Bone loss can be minimized by using the lowest effective dose of a glucocorticoid with a short half-life, maintaining good nutritional status and physical activity, limiting sodium intake and giving a thiazide diuretic, maintaining serum 25-OHD at the upper limits of the normal range, giving estrogen replacement therapy to postmenopausal and amenorrheic women, and giving testosterone to men with low serum testosterone levels. The use of calcitonin or bisphosphonates should be considered.
(C) 1992 Southern Medical Association