Management of bone disease in patients on long term glucocorticoid therapy.

Osteoporosis is a well documented complication of gastrointestinal disease. Its pathogenesis is multifactorial but glucocorticoid therapy is likely be an important contributory factor, particularly in patients with inflammatory bowel disease. A widely recognised condition, glucocorticoid induced osteoporosis is under diagnosed and often inadequately treated. Two recent surveys, one from a large teaching hospital and one community based, reported that only a small minority of patients receiving long term glucocorticoid therapy were oVered prophylaxis against bone loss. However, recent evidence shows that intervention can prevent bone loss and reduce the significant morbidity associated with glucocorticoid induced osteoporosis. 5 This emphasises the need to adopt a more aggressive approach towards prevention of osteoporosis, and to define management strategies for patients who are treated with glucocorticoids.