Osteoporosis is a common complication of glucocorticoid therapy and causes significant morbidity. Nevertheless, it remains relatively neglected and many patients on long term glucocorticoid therapy receive no prophylaxis against bone loss. However, recent evidence from randomised controlled trials, including that by Saaget al, suggests that bisphosphonates are effective in the prevention and treatment of glucocorticoid induced osteoporosis.1 ,2 These agents, which inhibit bone resorption, are already widely used in the prevention and treatment of postmenopausal osteoporosis.

In the largest study by Saag et al the effects of alendronate were investigated in patients taking a median dose of around 10 mg of prednisolone daily at baseline. After 48 weeks, significant treatment benefits were demonstrated on bone mineral density (BMD) in the spine and proximal femur and, although the study was not powered to demonstrate a reduction in fracture, the overall incidence of vertebral fractures was lower in treated patients. These results are similar to those reported by Adachi and colleagues¹ in a randomised controlled study of …