Case studies

Endocrine causes of osteoporosis. Part 2: Glucocorticoid-induced osteoporosis

Madhuni Herath, FRANCES MILAT, PHILLIP WONG

Figures

© science source/jim dowdalls
© science source/jim dowdalls

Abstract

Endocrine causes of osteoporosis, such as primary hyperparathyroidism, hypogonadism, glucocorticoid excess, acromegaly, Cushing’s syndrome and hyperthyroidism, are well-recognised risk factors for decreased bone mineral density. Optimal management of bone health in people with these conditions involves treating the underlying hormonal disease and assessing the need for specific bone preservation therapy. This three-part series discusses the management of three different cases to highlight the detrimental impact of specific endocrine disease on bone health.

Key Points

  • Glucocorticoid-related bone loss can occur within three months of starting glucocorticoids.
  • Maintaining the lowest dose of glucocorticoids reduces the long-term adverse effects on bone.
  • Bisphosphonate therapy can be considered and is PBS-subsidised for patients receiving high-dose glucocorticoids (equivalent to prednisolone 7.5 mg daily) long term (for three months or more) who have a BMD T-score of –1.5 or less, even in the absence of minimal trauma fracture.

Figures

© science source/jim dowdalls
© science source/jim dowdalls