A 48-year-old lady has been referred from her primary physician to rule out Cushing’s disease. She has been suffering with bronchial asthma for 20 years, with acute exacerbations at least 3 times/year requiring hospital admissions. She is on inhaled steroids everyday with use of oral steroids for 1–2 weeks at least 4–6 times/year. She is also diagnosed to have diabetes and hypertension for 5 years and is on treatment. She had sustained fracture of the left wrist following a trivial fall a year ago. On examination, she has central obesity, abdominal striae, thin skin and hypertension. Her primary physician ordered for an 8 am cortisol which showed 28 mg/dL. After receiving the patient, it is revealed that the patient was continuing to use prednisolone 10 mg/day without disclosing to her doctor. She is educated about being off all medications and a repeat 8 am cortisol is ordered which is 2 mg/dL this time suggesting exogenous cortisol use.
How should patients with glucocorticoid-induced osteoporosis be monitored?
Although BMD assessment is not the best modality to quantify micro- architectural damage caused by steroids, they still remain the main monitoring parameter in glucocorticoid induced osteoporosis, owing to a lack of a better feasible mode. The DXA scans should be performed at 1–2 years interval. In addition, at each visit the patient should have assessed the risk of falls, height, medication compliance, and if required, the concentration of 25-hydroxyvitamin D3 and an X-ray of the spine.
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