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Nephrol Dial Transplant (2003) 18: 861-864
© 2003 European Renal Association-European Dialysis and Transplant Association

Editorial Comment

Steroid-induced osteoporosis: how can it be avoided?

Peter M. Jehle

Klinik für Innere Medizin, Akademisches Lehrkrankenhaus der Martin-Luther-Universität Halle-Wittenberg, Lutherstadt Wittenberg, Germany

Keywords: bisphosphonates; calcium; HRT; osteoporosis; steroids; vitamin D

The first 10% of the full text of this article appears below.

Clinical significance of steroid-induced osteoporosis

In 1932, Harvey Cushing wrote: ‘The greatly compressed bodies of the vertebrae ... were so soft they could easily be cut with a knife’. Today, steroid-induced osteoporosis is still of major clinical relevance. Glucocorticosteroids induce a biphasic bone loss with a rapid initial phase of ~10–15% during the first few months and a slower phase of ~2–5% annually. As shown in Figure 1Go, steroids do not only reduce the lifespan and promote the apoptosis of osteoblasts and osteoclasts but also decrease the recruitment of osteoblasts and osteoclasts from progenitor cells [1]. Apoptosis and changes in the expression of bone growth factors contribute to a decline in bone formation and the occurrence of osteonecrosis.


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  		Fig. 1.  Effects of steroids on bone remodelling and mechanisms involved in the pathogenesis of steroid-induced osteoporosis.

 
Steroid therapy affects particularly the axial skeleton and the proximal . . . [Full Text of this Article]

Prevention and treatment of steroid-induced osteoporosis

Calcium and vitamin D
Active vitamin D metabolites
Bisphosphonates
Hormone replacement therapy
Calcitonin and fluorides
Summary

Note added in proof


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