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Bone formation appears to be suppressed by corticosteroids. Inhibition of proliferation and bone matrix synthesis of osteoblasts and promotion of bone resorption by osteoclasts. Direct steroid-induced decrease in IGF I and II (insulin-like growth factor) and TGF-ß. In addition, growth hormone and testosterone inhibition. Glucocorticoids inhibit active absorption of calcium ions in the intestine and promote calcium excretion by the kidney. Parathyroid hormone is activated.
Risk factors: previous vertebral fractures, postmenopausal women without hormone replacement therapy, hypogonadism or early menopause (< 45 LJ), age < 65 years, existing or planned corticosteroid use lasting more than 6 months, BMI < 20 kg m², alcohol abuse, rheumatoid arthritis, hyperparathyroidism.
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Hormone replacement therapy, if necessary with the involvement of a gynecologist.
Often helpful are bisphosphonates, e.g. alendronate tbl. (Fosamax) 10 mg/day p.o. or risedronate tbl. (Actonel) 5 mg/day peroral.
Supportive Fluoride (Ossin Tbl.) 50 mg/day p.o., Calcium 1000 mg/day (e.g. Calzium Sandoz forte) in combination with Vitamin D3 500 IU/day orally (e.g. Merck Vigantoletten 500). Supportive calcitonin 50-100 IU s.c. (e.g. Calcitonin Stada ampoules).
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- Angeli A et al (2002) Interactions between glucocorticoids and cytokines in the bone microenvironment. Ann N Y Acad Sci 966: 97-107
- Canalis E (2003) Mechanisms of glucocorticoid-induced osteoporosis. Curr Opin Rheumatol 15: 454-457
- Dawson-Hughes B (2001) Bone loss accompanying medical therapies. N Engl J Med 345: 989-991
- Niedermeier A et al (2001) Glucocorticoid-induced osteoporosis. A underestimated sequela of long-term treatment of autoimmune diseases. dermatologist 52: 477-483
- Solomon DH (2002) Management of glucocorticoid-induced osteoporosis in patients with rheumatoid arthritis: rates and predictors of care in an academic rheumatology practice. Arthritis Rheum 46: 3136-3142
- Watts NB et al (2003) Bisphosphonate treatment of osteoporosis. Clin Geriatr Med 19: 395-414
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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.
Prof. Dr. med. Peter Altmeyer