Vnitr Lek 1998, 44(2):86-92

[Steroid osteoporosis].

J Kocián: I. interní klinika IPVZ FTN, Praha.

The author demonstrates on a group of 292 patients (207 women, 85 men) treated on account of various diseases with corticoids laboratory parameters and bone density and records of bone fractures. The bone metabolism is negatively influenced by the action of corticoids on the vitamin D transformation into its active metabolites; as a result of reduced calcium absorption from the gut the reduced calcium level in blood causes secondary hyperparathyroidism and osteoclastic bone resorption is enhanced. On the other hand, corticoids inhibit new formation of bone by suppressing the proliferation of osteoblasts and by interfering with osteoid formation. One quarter of the patients suffers moreover from osteoporomalacia. Two and a half times as many women have steroid osteoporosis, and bone demineralization is enhanced also by other factors caused by the basic disease (immobilization, hypercalciuria, lactose intolerance). By comprehensive treatment using a combination of Ca + F, vitamin D, exercise, thyrocalcitonin, Osteogenon and recently also the third series of bisphosphonates it proved possible to increase within one year the bone density on average by 4.5% of normal values. The number of fractures declined dramatically.