Bone Research Society Bone Research Society

Glucocorticoid-induced osteoporosis

Glucocorticoid drugs are widely used in the treatment of rheumatoid arthritis, polymyalgia rheumatica, asthma, inflammatory bowel disease, skin diseases, connective tissue disorders and organ transplantation. These drugs affect the normal remodelling process in bones leading to a form of osteoporosis and increased risk of fractures. At any one time, glucocorticoid are in use by approximately 1% of the adult population although this figure increases to 2.5% in individuals aged 70-79. Accordingly it has been estimated that 350,000 individuals in the UK are at risk of fractures due to glucocorticoid use.

Recent evidence suggests that the risk of osteoporosis rises within 3 months of the initiation of therapy. Doses of only 5mg per day are associated with excess risk of vertebral fractures. It is now thought that even the use of inhaled glucocorticoids may have an effect.

What should I do if I think I am at risk?

Talk to your doctor about your worries. The Bone Research Society has collaborated with the Royal College of Physicians and the National Osteporosis Society to produce detailed guidelines for patients and also guidelines for doctors.

What are the symptoms?

The symptoms are the same as listed under osteoporosis.

How is it treated?

The most effective way of preventing or reversing glucocorticoid induced bone loss is with anti-resorptive drugs, specifically the bisphosphonates. Etidronate was the first to show an effect, but the evidence of efficacy with alendronate and risedronate, the latter in both prevention and treatment mode, is better. Both alendronate after two years and risedronate after 1 year, have shown an effect on prevention of vertebral fractures even after they are discontinued. Recent evidence has suggested that another drug, ibandronate, is also useful for reversing bone loss in patients receiving glucocorticoids.

Increasing the amount of calcium and Vitamin D in the diet is also important and weight-bearing exercise is recommended.

Questions patients ask

What are the most likely signs of glucocorticoid-induced osteoporosis?
The most likely indication is that a minor slip or fall unexpectedly causes a fracture.

More information

BRS, NOS and The Royal Society of Physicians
    Guidelines for Patients
    Guidelines for health professionals

 National Osteoporosis Society
 National Institute for Clinical Excellence