The ACR guidelines emphasize the role of calcium in the prevention and treatment of steroid-induced osteoporosis. According to the guidelines, all patients on corticosteroids should be on a strict calcium regimen of 1500 mg of calcium per day through either diet or supplements. Vitamin D also is important in the treatment and prevention of steroid-induced bone loss because it increases the absorption of calcium into the bones. Both vitamin D and its active form, calcitriol, slow bone loss in the lumbar spine when combined with calcium. Physicians should assess patients' calcium intake and make either dietary recommendations to increase calcium and vitamin D, or begin an immediate daily regimen with a calcium and vitamin D supplement.
Lifestyle modifications are also important in reducing the risk of steroid-induced osteoporosis.
The guidelines note that oral contraceptives may be effective in premenopausal women if not contraindicated, and men with low testosterone levels can benefit from testosterone replacement. Etidronate has been shown to be effective in the prevention of corticosteroid-induced osteoporosis. Alendronate is approved for the treatment of osteoporosis and is being studied for its efficacy against corticosteroid-induced osteoporosis. Trials of alendronate in secondary prevention are currently in progress. Calcitonin, a naturally occurring hormone, available by injection or intranasally, is approved for the treatment of osteoporosis and has been shown to be effective in the prevention of bone loss in patients receiving steroids.