Studies of oral corticosteroid dose and loss of bone mineral density have reported inconsistent results. In this meta-analysis, we used information from 66 papers on bone density and 23 papers on fractures to examine the effects of oral corticosteroids on bone mineral density and risk of fracture. Strong correlations were found between cumulative dose and loss of bone mineral density and between daily dose and risk of fracture. The risk of fracture was found to increase rapidly after the start of oral corticosteroid therapy (within 3 to 6 months) and decrease after stopping therapy. The risk remained independent of underlying disease, age and gender. We conclude that oral corticosteroid treatment using more than 5 mg (of prednisolone or equivalent) daily leads to a reduction in bone mineral density and a rapid increase in the risk of fracture during the treatment period. Early use of preventive measures against corticosteroid-induced osteoporosis is recommended.

/pdf/the-epidemiology-of-corticosteroid-induced-osteoporosis-a-4ra3qtx7u3.pdf

The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis.

One strategy for dealing with the burgeoning medical literature is to rely on reviews of the literature. Although this strategy is efficient, readers may be misled if the review does not meet scientific standards. Therefore, guidelines that will help readers assess the scientific quality of the review are proposed. The guidelines focus on the definition of the question, the comprehensiveness of the search strategy, the methods of choosing and assessing the primary studies, and the methods of combining the results and reaching appropriate conclusions. Application of the guidelines will allow clinicians to spend their valuable reading time on high-quality material and to judge the validity of an author's conclusions.

Guidelines for reading literature reviews.

Glucocorticoids, in supraphysiologic doses, exert both anti-inflammatory and immunosuppressive actions which have made them useful in the treatment of rheumatoid arthritis, asthma, and systemic lupus erythematosus (SLE). Unless these conditions can be prevented, we will continue to depend on glucocorticoids and related compounds to alleviate symptoms and to slow down the progression of the disease. Unfortunately, long-term administration of these compounds often leads to untoward effects involving cardiovascular, gastrointestinal, and musculoskeletal systems. The most disabling of these adverse effects is the development of osteopenia. Bone loss secondary to glucocorticoid administration is known to have a characteristic distribution. It is more severe in the regions with high trabecular bone content (spine and ribs), and less striking in predominantly cortical bone areas (Hann et al, 1979). Consequently, rib fractures and compression deformities of the vertebrae frequently occur.

Glucocorticoid-Induced Osteoporosis

Perspectives bone histomorphometry in glucocorticoid-induced osteoporosis

In a population-based study, the incidence of osteoporotic fractures in patients who have been diagnosed as having rheumatoid arthritis was investigated. This incidence was found to be increased, though not dramatically so: the relative risk for hip fracture, for example, was 1.5. Univariate analyses generally indicated increased risk associated with increasing age, earlier age at diagnosis of rheumatoid arthritis, disability, impaired ambulation, steroid use, and thinness, and decreased risk associated with obesity and estrogen use. In multivariate analyses, only aging, impaired ambulation, and thinness were identified as independent risk factors.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1002/art.1780271205

Fractures after rheumatoid arthritis. A population-based study

Determining causation--a case study: adrenocorticosteroids and osteoporosis. Should the fear of inducing clinically important osteoporosis influence the decision to prescribe adrenocorticosteroids?

Amir A. Mewa

Papers

Determining causation--a case study: adrenocorticosteroids and osteoporosis. Should the fear of inducing clinically important osteoporosis influence the decision to prescribe adrenocorticosteroids?