What are the recommended strategies for preventing corticosteroid-induced osteoporosis in patients starting long-term steroid therapy?

To prevent corticosteroid-induced osteoporosis in patients starting long-term corticosteroid therapy, initial assessment of fracture risk is essential, particularly in those on systemic glucocorticoids, using tools such as FRAX or QFracture to estimate 10-year fracture risk, even without bone mineral density (BMD) measurements ¹. Non-pharmacological strategies include ensuring adequate calcium and vitamin D intake, promoting weight-bearing exercise, smoking cessation, and limiting alcohol consumption ¹. Pharmacological intervention should be considered for patients at moderate to high fracture risk, especially those expected to be on glucocorticoids for more than 3 months at doses equivalent to prednisolone ≥5 mg daily ¹. Bisphosphonates are the first-line agents recommended to reduce fracture risk in this population ¹.

Regular monitoring of bone health, including repeat fracture risk assessment and BMD measurement where appropriate, is advised to guide ongoing management ¹. Additionally, minimizing corticosteroid dose and duration where clinically feasible can reduce osteoporosis risk ¹. Recent literature emphasizes the pathophysiology of glucocorticoid-induced osteoporosis, highlighting early rapid bone loss due to increased bone resorption and decreased formation, which supports the need for early preventive measures (Chiodini et al., 2020). Emerging therapies and tailored approaches based on individual risk profiles are under investigation but bisphosphonates remain the cornerstone of prevention (Chiodini et al., 2020).