Corticosteroid-Induced Osteoporosis (CIO)

WHAT IS CIO?
Corticosteroids such as prednisone or methylprednisolone are valuable, commonly prescribed medications utilized in the treatment of many diseases, including, rheumatic, respiratory and intestinal ailments. CIO (also referred to as steroid or glucocorticosteroid-induced osteoporosis) is the most common form of drug-induced osteoporosis. It typically develops when corticosteroids are taken for prolonged periods of time. The higher the dose and longer the duration of treatment with corticosteroids, the greater the risk of developing osteoporosis and fractures.
WHY DO CORTICOSTERIDS INDUCE OSTEOPOROSIS?
The production of strong healthy bone is dependent on a balance between the factors that stimulate bone growth versus those that break down bone. In CIO, the forces favoring the break down of bone outweigh those of bone formation that leads, in turn, to osteoporosis. In addition, corticosteroids can decrease the absorption of calcium from the intestine.
HOW IS CIO DIAGNOSED?
The use of DEXA remains the best tool to measure bone density. Because bone loss occurs rapidly after starting corticosteroids, the American College of Rheumatology's Task Force on Osteoporosis has recommended obtaining a DEXA at the start of treatment with corticosteroids. This test should be rechecked one year after initiating corticosteroids treatment to determine if clinically significant changes in bone density have developed.
HOW IS CIO TREATED?
The therapeutic options listed for osteoporosis similarly apply to CIO. Using the lowest possible dose of corticosteroids for the briefest period of time or, when medically indicated, switching to a non- corticosteroids drug is advised. However, it is important to remember that the pre-treatment identification of persons at risk of CIO remains one of the most important weapons to combat CIO. People with low bone mass at the start of corticosteroid treatment, such as post-menopausal women who have not taken estrogen and the elderly, are at highest risk of sustaining a fracture; men and pre-menopausal women are also at risk.
FOR MORE INFORMATION
www.rheumatology.org
www.arthritis.org