ABSTRACT
Introduction: Corticosteroids have major effects on calcium metabolism, leading to accelerated osteoporosis and fracture.
Methods: This review will attempt to summarise current knowledge about their effects in light of new information and important remaining questions, especially with respect to management of this common condition. Results: Corticosteroids affect bone through multiple pathways, influencing both bone formation and bone resorption. Evidence from randomised trials suggests that postmenopausal women receiving corticosteroids are at greatest risk of rapid bone loss and consequent fracture and should be actively considered for prophylaxis. Based upon available evidence, the rank order of choice for prophylaxis would be a bisphosphonate followed by a vitamin D metabolite or hormone replacement. Conclusions: With early therapy, corticosteroid bone loss can be effectively prevented or reversed.Corticosteroids are known to affect bone through multiple pathways (Fig. 1), influencing both bone formation and bone resorption, and these mechanisms have been reviewed. The most important effects appear to be on bone formation due to direct effects on cells of the osteoblastic lineage although indirect effects related to sex steroid production are also important.
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