How often should I monitor bone mineral density in patients on chronic corticosteroid treatment?

In patients receiving chronic corticosteroid treatment, bone mineral density (BMD) monitoring should be considered based on fracture risk assessment and clinical context rather than at fixed intervals. Initial assessment of fracture risk using tools such as FRAX or QFracture is recommended before measuring BMD with dual-energy X-ray absorptiometry (DXA) ². If the patient’s fracture risk is near an intervention threshold or if they are on high-dose systemic glucocorticoids (more than 7.5 mg prednisolone equivalent daily for 3 months or longer), BMD measurement is advised before or early in treatment ².

Following the initial BMD assessment, repeat scans should generally be performed no more frequently than every 2 years, unless there is a significant change in clinical risk factors or new fractures occur ². This interval allows for meaningful detection of changes in bone density while avoiding unnecessary radiation exposure and resource use. In children and young people treated with systemic corticosteroids, monitoring of growth and bone health should be more frequent, typically every 3 to 6 months during active disease or corticosteroid treatment, to detect early adverse effects on bone and development ¹.

Recent literature supports these recommendations, emphasizing that glucocorticoid-induced osteoporosis requires individualized monitoring strategies based on dose, duration, and patient risk factors (Paccou et al., 2024). Frequent BMD monitoring more often than annually is generally not recommended unless clinically indicated (Reid and Grey, 1993; Vidal et al., 2019). Thus, in adults on chronic corticosteroids, BMD should be assessed at baseline and then repeated approximately every 2 years or sooner if clinical circumstances change.