Two types of transdermal patches are available. Possible side effects should be monitored regularly. If hypogonadism is not present, one should consider use of osteoporosis agents approved for women or referral to a specialist. There are no large clinical randomized drug treatment trials in men. Some small short term trials of a number of non-hormonal treatments such as alendronate, etidronate and calcitonin are available and there does not appear to be any contraindication to their use.
Steroids also have effects on reducing sex hormones and reducing intestinal calcium absorption.
Most bone is lost within the first 6 months and consideration of ongoing attempts to prevent osteoporosis should start at the time of the visit in which corticosteroid is being prescribed. The lowest possible dose of glucocorticoid should be given. The lowest dose of glucocorticoid that affects bone is not known, but osteoporosis treatment should be considered for patients taking 7.5 mg per day or greater of prednisone for 6 months or more. HRT or testosterone should be considered to correct the sex hormone suppression that occurs in women or men respectively. Several small trials of bisphosphonates including etidronate and parnidronate, have shown prevention of steroid induced bone loss.