Etidronate has been shown to be effective in primary prevention, and both etidronate and pamidronate have been shown to be effective in the secondary prevention of glucocorticoid-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. Lifestyle modifications are also important in reducing the risk of steroid-induced osteoporosis. All patients should be encouraged to modify their lifestyles to include smoking cessation, limitation of alcohol consumption and participation in a weight-bearing exercise program for 30 to 60 minutes daily.
Regular exercise can maintain or increase muscle strength.
Patients should receive exercise advice and training from a physician or physical therapist. The guidelines recommend baseline bone density measurements of the lumbar spine and femoral neck to evaluate any patient who is considered for six or more months of corticosteroid therapy. A follow-up visit should be scheduled in six to 12 months to determine whether therapeutic interventions have been effective against bone loss. Therapeutic interventions should continue if a patient's bone mineral density increases, has remained stable or has declined by 5 percent or less. For patients whose bone mineral density has decreased more than 5 percent, reevaluation or referral to a specialist is recommended.