Currently, it’s recommended that patients who are treated with corticosteroids at doses equal to or greater than 7.5 mg/day for more than three months should be given a bisphosphonate to prevent bone loss, in addition to appropriate calcium and vitamin D. Those at greatest risk for fracture are those with the most risk factors — previous fracture, older age, post-menopausal status and family history.

One question that frequently arises is what to do for patients on short-term corticosteroids, for whom the duration of therapy is as yet indeterminate. In these cases, it’s helpful to assess the entire clinical picture as above, and of course obtaining BMD to determine risk profile. All long-term corticosteroid patients should have BMD assessment, but treatment need not be delayed in the appropriate circumstances until BMD has been obtained. In fact, early initiation is recommended, because the greatest loss will occur early in the course of treatment. Remember to perform thoracolumbar spine views for spinal fracture documentation as this is helpful in defining risk and documenting pre-existing conditions.

ENTER KEYWORD(S)

To search a phrase, use quotation marks (e.g. "back pain")