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Glucocorticoid-Induced Osteoporosis: Pathogenesis and Management

Barbara P. Lukert, MD; and Lawrence G. Raisz, MD
[+] Article, Author, and Disclosure Information

Requests for Reprints: Barbara P. Lukert, MD, University of Kansas Medical Center, Room 4023C, 39th Street and Rainbow Boulevard, Kansas City, KS 66103.

Current Author Addresses: Dr. Lukert: University of Kansas Medical Center, Room 4023C, 39th Street and Rainbow Boulevard, Kansas City,KS 66103.

Dr. Raisz: University of Connecticut Health Center, Farmington, CT 06032.

© 1990 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1990;112(5):352-364. doi:10.7326/0003-4819-112-5-352
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Purpose: To review the clinical picture, pathogenesis, and management of glucocorticoid-induced osteoporosis.

Data Identification: Studies published since 1970 were identified from a MEDLINE search, articles accumulated by the authors, and through bibliographies of identified articles.

Study Selection: Information for review was taken from 160 of the more than 200 articles examined.

Data Extraction: Pertinent studies were selected; the relative strengths and weaknesses of these studies are discussed.

Results of Data Synthesis: Studies in tissue and organ cultures suggest that glucocorticoids have a direct effect on bone, causing inhibition of bone formation and enhancing bone resorption. Glucocorticoids decrease calcium absorption from the intestine and increase renal excretion. Osteoporosis occurs in at least 50% of persons who require long-term glucocorticoid therapy. Long-term trials of therapy for the prevention of glucocorticoid-induced osteoporosis have not been done, but reasonable recommendations include the use of a glucocorticoid with a short half-life in the lowest dose possible, maintenance of physical activity, adequate calcium and vitamin D intake, sodium restriction and use of thiazide diuretics, and gonadal hormone replacement. In refractory cases, the use of calcitonin, bisphosphonates, sodium fluoride, or anabolic steroids should be considered.

Conclusions: Osteoporosis is common in patients requiring long-term treatment with glucocorticoids. Careful attention to preventive management may minimize the severity of this serious complication.





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