A Canadian survey on the management of corticosteroid induced osteoporosis by rheumatologists

J Rheumatol. 2000 Jun;27(6):1506-12.


Objective: To survey the practice pattern of Canadian rheumatologists (CR) on their management of corticosteroid induced osteoporosis in their premenopausal (PrM) and postmenopausal (PoM) female patients.

Methods: The practice pattern was surveyed using a 17 item questionnaire probing the diagnosis, prevention, treatment, and monitoring of osteoporosis in PrM and PoM women receiving longterm oral systemic corticosteroid therapy.

Results: Most CR investigated and treated osteoporosis themselves, 13% referred to other specialists for investigation, and 22% referred for treatment. Eighty-two percent of CR used dual energy x-ray absorptiometry (DEXA) to confirm a diagnosis of osteoporosis. Most CR initiated investigation for osteoporosis at the start or within the first year of starting longterm systemic corticosteroid therapy: PrM 87% and PoM 93%. The most frequently used initial strategy for the prevention of osteoporosis was as follows. PrM: calcium and vitamin D3 (53%); PoM: hormone replacement therapy (HRT) and calcium (29%). The most common initial choice for treatment of established osteoporosis was as follows: PrM: etidronate (53%); PoM: bisphosphonates +/- HRT (53%). Ninety-six percent of CR used only bone mineral density (BMD) measurement to monitor therapy for corticosteroid induced osteoporosis. Most CR monitored BMD every 12 to 24 months for PrM (81%) and PoM (84%). The BMD parameter(s) (T and Z scores as measured by DEXA) used to initiate therapy for corticosteroid induced osteoporosis was variable.

Conclusion: It appears that, while certain trends are evident, there is still considerable variability in the management of corticosteroid induced osteoporosis.

MeSH terms

  • Absorptiometry, Photon / statistics & numerical data
  • Adrenal Cortex Hormones / adverse effects*
  • Adult
  • Alendronate / therapeutic use
  • Bone Density
  • Calcitonin / therapeutic use
  • Canada
  • Data Collection
  • Etidronic Acid / therapeutic use
  • Female
  • Hormone Replacement Therapy
  • Humans
  • Middle Aged
  • Osteoporosis / chemically induced*
  • Osteoporosis / diagnostic imaging
  • Osteoporosis / drug therapy*
  • Osteoporosis / prevention & control
  • Postmenopause
  • Practice Management, Medical*
  • Practice Patterns, Physicians'
  • Premenopause
  • Referral and Consultation / statistics & numerical data
  • Rheumatology / statistics & numerical data*
  • Surveys and Questionnaires


  • Adrenal Cortex Hormones
  • Calcitonin
  • Etidronic Acid
  • Alendronate