This article in the Drug and Therapeutics Bulletin (DTB) provides advice on prophylaxis and treatment for osteoporosis in adults receiving corticosteroid therapy. The following topics are addressed:

• About osteoporosis

• How corticosteroids affect bone

• General advice

• Calcium and vitamin D supplements

• Drug treatment

• Bisphosphonates: IV, oral, contraindications and unwanted effects

• Teriparatide

• Other drugs

• Who needs referral?

The article notes that there is increased risk of bone loss and fractures, particularly at doses and durations above 5mg prednisolone daily (or equivalent) for 3 months. At present, much of the evidence on drug treatments for preventing fracture is extrapolated from that in post-menopausal osteoporosis which has a different pathogenesis, therefore more research is needed to determine the most effective preventive and treatment strategy in people at risk of corticosteroid-induced osteoporosis. In the meantime, patients should be counselled about lifestyle measures, and individual patient’s risk of corticosteroid-induced osteoporosis should also be considered, such as corticosteroid dose, duration of treatment, postmenopausal status and any history of low-trauma fracture. In patients needing bone protective therapy, treatment with a bisphosphonate (alendronate is the cheapest) and calcium and vitamin D supplements should be offered as close as possible to the start of corticosteroid therapy, and continued for its duration.