Abstract

INTRODUCTION

Glucocorticoids are widely used by a number of medical specialists, including neurologists. A recent study using the UK General Practice Research Database identified 1.6 million oral glucocorticoid prescriptions over a 10-year period in 683 practices from different geographic areas of the UK (van Staa et al. 2000). At any one time, the prevalence of oral glucocorticoid use was 0.9% of the total adult population, rising to 2.5% of those aged 70–79 years. However, the use of bone active medication in this population was extremely low (5% used hormone replacement therapy and only 1.8% used bisphosphonates). And yet, osteoporosis is a common and serious complication of treatment with glucocorticoids, being associated with an increased risk of vertebral and hip fractures.

Some important characteristics of glucocorticoid-induced bone loss have recently been identified:

• Even during the first few months of therapy the onset of bone loss is rapid and the