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Are adults taking corticosteroids for adrenal insufficiency at risk of osteoporosis?

Publisher: North West Medicines Information Centre

Date published: 01/01/2011 10:21

Review date: 31/01/2013 10:00

Summary
by: Joanne McEntee
  • Evidence from observational studies indicates that some adults taking corticosteroids for adrenal insufficiency (AI) have decreased bone mineral density (BMD). Two prospective studies reported that corticosteroid replacement therapy causes a dose-dependent reduction in serum levels of osteocalcin, a surrogate marker for bone formation. The risk of bone density loss may be influenced by cumulative or daily corticosteroid dose and co-existent hormone imbalances.
  • Accurate replacement of physiological levels of cortisol is impossible with currently available corticosteroids. There is also no objective method of monitoring the accuracy of replacement in order to avoid over- or under-treatment.
  • The traditionally recommended dose of hydrocortisone of 20 to 30mg daily may be too high for many patients. New techniques for measuring cortisol production indicate that the rate is much lower than previously estimated and most adult patients can be treated successfully with 15 to 20mg daily (or 10 to 12mg/m2/day).
  • Adults with AI who have been receiving daily hydrocortisone doses higher than 25mg (or equivalent) should be considered to have a clinical risk factor for fracture, and their ten year major fracture risk should be assessed and managed as recommended in national osteoporosis guidelines. In all patients with AI, calcium and vitamin D intake should be optimised and weight bearing exercise and a well balanced diet encouraged; they should be advised to stop smoking and limit their alcohol intake.
About this library entry
Category: 6.3.2 Glucocorticoid therapy | Bone Diseases | Endocrinology
NeLM area:  Evidence > Medicines Q & A
114_2_AI_and_osteoporosis_final.doc

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