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][4] 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.[5] Alternate day use may not prevent this complication.[6]

Steroid-induced osteoporosis
Other namesSIOP
Medicationprednisone

It is also known as glucocorticoid-induced osteoporosis.[7]

Mechanism

Mechanisms of SIOP include:[8]

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

The combination of these changes leads to drug-induced nutrient depletion. Prednisone moderately depletes calcium,[9] vitamin D,[10] chromium[11] and magnesium. This explains why the professional guidelines recommend calcium and vitamin D supplementation.[12]

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.

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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. Buckley, Lenore; Guyatt, Gordon; Fink, Howard A.; Cannon, Michael; Grossman, Jennifer; Hansen, Karen E.; Humphrey, Mary Beth; Lane, Nancy E.; Magrey, Marina; Miller, Marc; Morrison, Lake (August 2017). "2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis". Arthritis Care & Research. 69 (8): 1095–1110. doi:10.1002/acr.23279. ISSN 2151-4658. PMID 28585410.
  5. 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.
  6. 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.
  7. Buckley, Lenore; Guyatt, Gordon; Fink, Howard A.; Cannon, Michael; Grossman, Jennifer; Hansen, Karen E.; Humphrey, Mary Beth; Lane, Nancy E.; Magrey, Marina; Miller, Marc; Morrison, Lake (August 2017). "2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis". Arthritis Care & Research. 69 (8): 1095–1110. doi:10.1002/acr.23279. ISSN 2151-4658. PMID 28585410.
  8. Steroid-induced osteoporosis By Susan Ott, MD. Updated January 28, 2009. Retrieved on 26 March 2009
  9. "Office of Dietary Supplements - Calcium". ods.od.nih.gov. Retrieved 2020-07-24.
  10. "Office of Dietary Supplements - Vitamin D". ods.od.nih.gov. Retrieved 2020-07-24.
  11. "Office of Dietary Supplements - Dietary Supplement Fact Sheet: Chromium". ods.od.nih.gov. Retrieved 2020-07-24.
  12. Buckley, Lenore; Guyatt, Gordon; Fink, Howard A.; Cannon, Michael; Grossman, Jennifer; Hansen, Karen E.; Humphrey, Mary Beth; Lane, Nancy E.; Magrey, Marina; Miller, Marc; Morrison, Lake (August 2017). "2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis". Arthritis Care & Research. 69 (8): 1095–1110. doi:10.1002/acr.23279. ISSN 2151-4658. PMID 28585410.
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