Background: Glucocorticoid steroids are widely used as antiinflammatory and immunosuppressive medications and are well known to induce osteoporosis.
Material and methods: Randomised clinical trials and Cochrane reports on the use of calcium, vitamin D, bisphosphonates and hormones were reviewed and the results summarised. Additionally, national and some international recommendations were reviewed in order to propose recommendations for prophylaxis and treatment. The literature was identified by Medline searches.
Results and interpretation: Calcium and vitamin D prevent bone loss in low-to-medium-dose glucocorticoid steroid therapy. Bisphosphonates maintain or modestly increase lumbar and hip bone mass. The fracture risk was not significantly reduced in the spine and the hip. The clinical randomised trials and Cochrane reports conclude that bisphosphonates as well as calcium and vitamin D taken together are effective and the drugs of choice in prevention and treatment.