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In my country, many older people consumed corticosteroids. Its really a god’s drug, but do they know it can induced osteoporosis. Many postmenopausal women and older men receiving corticosteroids are probably at the greatest risk of rapid bone loss and consequent vertebral fracture and should be strongly considered for preventive measures. In younger individuals receiving corticosteroids, the decision to use osteoporosis prevention is less straightforward and will depend upon a number of factors including baseline BMD, anticipated dose and duration of corticosteroids and other risk factors. Based upon available evidence the rank order of choice for prophylaxis would be a bisphosphonate followed by an active vitamin D metabolite or HRT.

Although calcium alone appears unable to prevent rapid bone loss in patients starting corticosteroids, it should be considered in those patients with normal BMD values. If an active vitamin D metabolite is used, calcium supplementation should be avoided unless dietary calcium intake is low. The evidence for hormone replacement is limited, but HRT should be considered if hypogonadism is present. Addition of a bisphosphonate in postmenopausal patients already taking estrogen replacement therapy may enhance the bone density response. In patients receiving chronic low dose corticosteroids, treatment with calcium and vitamin D may help to prevent further bone loss.

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