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Osteoporosis - preventing steroid-induced - Management
Basis for recommendation

These recommendations are based on the Royal College of Physicians guideline, Glucocorticoid-induced osteoporosis [RCP, 2002].

Corticosteroids and bone mineral density

  • Prior and current exposure to oral corticosteroids is associated with an increased risk of fracture. The magnitude of risk is of substantial importance, and is beyond that explained by low bone mineral density (BMD). This is based on evidence from a meta-analysis of seven cohort studies (n = 42,000) which included men and women followed up for 176,000 patient-years [Kanis et al, 2004].

People 65 years of age or more, or less than 65 years of age with a previous fragility fracture

  • Increasing age and a previous fragility fracture are both associated with an increased risk of fracture, which is independent of low BMD. Therefore, all older people and those younger people with a history of fragility fracture should be considered to be at high risk of fracture (regardless of their T-score), and should be started on treatment to prevent corticosteroid-induced osteoporosis. For more information on the risk of fracture with increasing age or a history of previous fragility fracture, see the CKS topic on Osteoporosis - treatment.

People less than 65 years of age without a previous fragility fracture

  • People less than 65 years of age without a fragility fracture are at a lower risk of fracture, and require a DXA scan to assess BMD before starting drug treatment to prevent corticosteroid-induced osteoporosis.

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