Clinical calcium
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Glucocorticoid-induced osteoporosis is one of the most important side effects of glucocorticoid use, as it leads to an increased risk of fracture. The skeletal effects of glucocorticoids include both direct and indirect actions on bone that result in an early, transient increase in bone resorption accompanied by a decrease in bone formation, which is maintained for the duration of glucocorticoid therapy. ⋯ Bisphosphonates are the front-line choice for prevention of fracture in glucocorticoid-treated patients, with teriparatide as the second-line option ; calcium and vitamin D supplements should be co-prescribed in the majority of individuals. Fracture risk can be assessed using the FRAX(®) algorithm, although risk may be underestimated in patients taking higher doses of glucocorticoids.