Epidemiology of glucocorticoid-induced osteoporosis - Concepts and controversies

Long-term use of glucocorticoids is causally related to osteoporosis. Prescribing patterns of glucocorticoids for rheumatoid arthritis and the understanding of the term "low dose" glucocorticoid therapy vary greatly among physicians, important risk factors for glucocorticoid-induced bone loss include high doses, long-term use, low baseline bone mineral density, history of fractures, and postmenopausal state. Although an unequivocally safe dose of glucocorticoid has not been identified, doses <5 mg/day may result in less toxicity to bone. Despite the substantiated toxicity, only a small proportion of glucocorticoid users receive preventative therapy for osteoporosis. Studies that associate glucocorticoid therapy and bone loss should be evaluated critically because dose, duration of therapy, technique used to measure bone mineral density, and site of measurement often vary and may affect the interpretation of study results.