Grade A, meta-analysis of randomised, controlled trials or from at least one randomised, controlled trial, or from at least one well designed, controlled study without randomisation; grade B, from at least one other type of well designed, quasi-experimental study, or from well designed, nonexperimental studies (e.g. comparative studies, correlation studies, case-control studies); grade C, from expert committee reports/opinions and/or clinical experience of authorities. ND, not demonstrated. Data from the Royal College of Physicians and the Bone and Tooth Society.

Fig. 38.1 The prevention of osteoporosis.With permission from J Manson, Harvard Medical School and the New England Journal of Medicine

rate of bone loss occurs during the first 6-12 months of corticosteroid use. Patients taking the equivalent of prednisolone 7.5 mg or more each day for 3 months or longer should be considered for prophylactic treatment, and this is mandatory in those over 65 years. Treatment for osteoporosis should be given when a patient taking a corticosteroid sustains a low-trauma fracture. Long-term use of inhaled corticosteroids may reduce bone mineral density and place patients at risk. The treatment options for both the prophylaxis and treatment are: hormone replacement (HRT in women, testosterone in men), a bisphosphonate and calcitriol.

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