From the Guidelines
Steroid-induced osteopenia is a significant concern that requires immediate attention, and I strongly recommend calcium and vitamin D supplementation, as well as lifestyle modifications, to mitigate bone loss. The effects of steroid-induced osteopenia are multifaceted, and it is essential to address the various factors that contribute to bone loss. According to the British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults 1, patients receiving corticosteroids should be advised to stop smoking, reduce excess alcohol intake, and engage in regular muscle-building and weight-bearing exercise.
- Key recommendations for preventing steroid-induced osteopenia include:
- Calcium supplementation with 800-1000 mg/day
- Vitamin D supplementation with 800 IU/day
- Regular physical exercise
- Smoking cessation These measures can help prevent bone loss from the lumbar spine and forearm, as confirmed by a Cochrane review of five trials 1. It is also crucial to note that calcium supplementation may increase cardiovascular risk, particularly if not accompanied by vitamin D supplementation 1. Therefore, a strong recommendation is made for all patients receiving a course of corticosteroids to receive an intake of 800-1000 mg/day calcium and 800 IU/day vitamin D, along with lifestyle modification advice 1.
From the FDA Drug Label
Sustained use of glucocorticoids is commonly associated with development of osteoporosis and resulting fractures (especially vertebral, hip, and rib). It occurs both in males and females of all ages. Osteoporosis occurs as a result of inhibited bone formation and increased bone resorption resulting in net bone loss
The effects of steroid-induced osteopenia (bone loss) include inhibited bone formation and increased bone resorption, resulting in net bone loss and an increased risk of fractures, particularly in the vertebral, hip, and rib areas. 2
From the Research
Effects of Steroid-Induced Osteopenia
The effects of steroid-induced osteopenia (bone loss) are significant and can lead to various complications. Some of the key effects include:
- Bone loss occurs soon after corticosteroid therapy is initiated and results from a complex mechanism involving osteoblastic suppression and increased bone resorption 3
- The greatest rate of bone loss occurs during the first 6 to 12 months of steroid therapy, affecting trabecular more than cortical bone 4
- High steroid dosage for a prolonged period, prevalent fracture, hypogonadism, older age, low calcium intake, and family history of osteoporosis are risk factors for steroid-induced bone loss 4
Prevention and Management
Prevention and management of steroid-induced osteopenia are crucial to minimize its effects. Some of the strategies include:
- Using the lowest effective dose of corticosteroids, with topical corticosteroids used whenever possible 3
- Maintaining an adequate daily intake of calcium (1000 mg/day) and cholecalciferol (400 to 800 U/day) 3
- Stopping smoking and avoiding excessive alcohol intake 3
- Detecting and treating hypogonadism in men, if present, and replacing gonadal hormones in postmenopausal women or amenorrhoeic premenopausal women 3
- Using bisphosphonates, which are considered the most effective and first-line agents for increasing bone mineral density and decreasing the risk of fracture 5, 4
Treatment Options
Various treatment options are available for steroid-induced osteopenia, including:
- Bisphosphonates, which are potent inhibitors of bone resorption 5, 4
- Human parathyroid hormone, which has emerged as a promising agent for the treatment of severe steroid-induced osteoporosis 6, 5
- Teriparatide, which is an anabolic therapy that can improve skeletal microarchitecture and reduce the risk of fractures 7, 6