The effect of corticosteroid therapy on development of osteoporosis

Abstract

Osteoporosis is a systemic skeletal disorder with reduced bone mass and deterioration of bone tissue microarchitecture. The aim of this paper is presenting difficulties in osteoporosis treatment in patients with two direct etiologic agents- rheumatoid arthritis and long-term corticosteroid use and with multiple predisposing factors for metabolic bone disorder development. A female patient, 57 year old, obese, smoker, with insufficient physical activity, suffered from rheumatoid arthritis in 2004. The first treatment included chloroquine and methylprednisolone (daily doses of 4 mg and 8 mg successively). After two years, chloroquine has been stopped and the treatment with methotrexate and glucocorticoids sustained. Additional medications included: folic acid, diclofenac, naproxen, iron (oral preparations), pantoprazole and betamethasone disodium phosphate plus betamethasone dipropionate injection (occasionally). Osteodensitometry findings proved osteoporosis (T-score, 1.8-2.5), and prevention and treatment of bone loss was performed with: calcium gluconate plus ascorbic acid (500 mg and 50 mg), cholecalciferol (1000 IU daily), alfacalcidol (100 mcg daily), alendronate (70 mg, weekly). Despite the therapy, the disease worsened and, due to significant functional limitations, the patient was operated and total cemented right hip arthroplasty was performed. Antirheumatic drug protocol in early 2012 included methylprednisolone and methotrexate. Artroplasty of contralateral hip was postponed until the next remission of underlying disease. Prevention and treatment of bone loss was suboptimal due to multiple risk factors for osteoporosis: older age, female gender, menopause, smoking, poor diet habits, lack of exercise and daylight exposure, primary disease (rheumatoid arthritis) and long-term corticosteroid therapy.