In this situation, it is very important to ensure adequate vitamin D (around 800 IU/day) and calcium (1200-1500 mg/day) intake. In addition, keeping alcohol intake to less than 1 drink/day, weight bearing exercises (eg, walking, stair climbing), and not smoking are also important. Bone density should be checked in follow up, and if there is significant, ongoing bone loss over time that is not being prevented by these measures, then medications such as Evista or a bisphosphonate can be used. One has to be careful, however, that the degree of change in the DXA bone density measurement is beyond the error or “noise” in the measurement.

Patients on steroids are at particularly high risk for bone loss and fractures. Fortunately, a number of drugs (bisphosphonates, teriparatide) have now been shown to be effective in preventing (or reversing, in the case of teriparatide) bone loss associated with steroid use. Thus, close follow up of bone density and medications to prevent bone loss are very important. The good news is that these measures are very effective in preventing fractures in patients such as yourself.