Minimising fracture risk in older people taking long-term oral corticosteroids

Corticosteroids have potent anti-inflammatory and immunosuppressant properties but are associated with a number of serious adverse events. When taken orally for longer than 3 months, particularly at prednisolone-equivalent doses greater than 5 mg per day, corticosteroids are associated with a high incidence of bone loss, muscle atrophy and weakness. Fracture risk is increased as a result of corticosteroid-induced bone loss and muscle weakness. Corticosteroid-related fractures are a serious complication of long-term oral corticosteroid therapy. The aim of this article is to provide practical information to help clinicians to minimise fracture risk in older people taking long-term oral corticosteroids. When therapy is instigated for longer than 1 month, identify at-risk patients promptly and consider a calcium and vitamin D supplement and fracture prevention therapy. Patients at risk include those receiving prednisolone-equivalent doses of more than 5 mg per day for longer than 3 months and patients receiving frequent short courses of high-dose corticosteroids.