By: 3 May 2012
Measures to help reduce the risk of fracture must be taken for individuals  on longer-term oral glucocorticoid therapy

In their newly issued joint guidance paper for health professionals worldwide, the International Osteoporosis Foundation (IOF) and the European Calcified Tissue Society (ECTS) have warned that specific precautions to help reduce the risk of bone loss and fracture must be taken for individuals on longer-term oral glucocorticoid therapy.

Professor Cyrus Cooper, chair of the IOF Committee of Scientific Advisors, commented, “Patients who are taking prednisolone, cortisone or other glucocorticoids for three months or longer, should be advised to take appropriate measures to help reduce the accompanying bone loss. While osteoporosis itself is painless, fractures resulting from osteoporosis can cause significant pain and lead to immobility, long-term disability and even higher risk of death.”

Generally, the higher the dose and the longer the glucocorticoid treatment continues, the higher the risk of fracture. People who take glucocorticoids orally or intravenously are at greater risk than those who inhale glucocorticoids for asthma, or apply lotions to the skin. However, using a high-dose steroid inhaler in the long term may also increase the risk of fracture. Injections of glucocorticoids into joints are not thought to affect the skeleton.

In terms of age, men and women over 70, and postmenopausal women and men over 50 who have had a previous fracture or take high doses of glucocorticoid, are at greater risk than younger men and women. Nevertheless, even younger people on glucocorticoids are advised to take precautions to help reduce bone loss. Dr. Tobie de Villiers, president of the International Menopause Society (IMS), commented, “Bone loss is a concern for all women around the age of menopause, and especially for the almost 5% of postmenopausal women worldwide who take oral glucocorticoid therapy. The IMS encourages women to be aware of this potentially dangerous side-effect of therapy and to discuss what precautions can be taken with their doctors.”

As bone loss occurs rapidly in the first three to six months of treatment, patients should be taking preventive action from the start: they must ensure adequate amounts of calcium and protein in their diet, get enough vitamin D through safe exposure to sunlight and do regular weight-bearing exercise to keep bones and muscles active. It is also important that they stop smoking, and reduce alcohol intake. Supplement tablets, especially of vitamin D, may be prescribed as it is often difficult to ensure adequate levels through diet and sunlight.