Osteoporosis CMAJ 1997;156:1534 The consensus statements from the Scientific Advisory Board of the Canadian Osteoporosis Society are, in general, a welcome update for the primary care physician. However, the rather sparse comments on the management of steroid-induced osteoporosis were rather disappointing. In "The use of bone density measurement in the diagnosis and management of osteoporosis" (CMAJ 1996;155[suppl]:924-9 [full text]), Dr. William Sturtridge and colleagues recommend that "if significant bone loss has occurred, a bone density measurement may aid in the decision to intervene with calcium and vitamin D supplementation." Several studies have now shown that significant bone loss (in the order of 10% to 20%) occurs within 6 to 12 months of starting treatment with supraphysiologic doses of glucocorticoids (greater than 10 mg) in approximately 60% of patients,[1] and a portion of this loss is irreversible. Therefore, it is appropriate to recommend a bone density assessment at baseline and appropriate intervention if there is evidence of osteopenia. Furthermore, there is little evidence that either calcium or vitamin D supplementation constitutes effective prophylaxis against steroid-induced osteoporosis.[2] Although recommending supplementation is standard practice among many physicians when steroid therapy is initiated, it is arguably more cost-effective to initiate bisphosphonate therapy in all patients receiving supraphysiologic doses of steroids.[3] A separate consensus statement on steroid-induced osteoporosis would have been more appropriate than this article's unnecessarily conservative statements, which do not reflect currently available evidence or modern standards of practice. Walter P. Maksymowych, MD Consultant Rheumatologist Associate Professor of Medicine University of Alberta Edmonton, Alta. References Gennari C, Civitelli R. Glucocorticoid- induced osteoporosis. Clin Rheum Dis 1986;12:637-54. Adachi J, Bensen W, Bianchi F, et al. Vitamin D and calcium in the prevention of corticosteroid-induced osteoporosis: a three year follow-up study. J Rheumatol 1996;23:995-1000. Mulder H, Struys A. Intermittent cyclical etidronate in the prevention of corticosteroid induced bone loss. Br J Rheumatol 1994;33:348-50. Send a letter to the editor responding to this letter Envoyez une lettre à la rédaction au sujet de cette lettre | CMAJ June 1, 1997 (vol 156, no 11) / JAMC le 1er juin 1997 (vol 156, no 11) |