Background Long-term glucocorticoid therapy, a major risk factor for the development of osteoporosis, is often necessary in chronic-rheumatic patients. Generally accepted guidelines for either the prevention of- or the therapy of steroid-induced osteoporosis do not exist to date.

Objectives In an open prospective study, we examined 99 patients with chronic-rheumatic diseases, who were treated with 5 mg or more equivalent dose of prednisolone/day for at least one year. The study goal was to identify factors which influence the manifestation of osteoporosis besides glucocorticoid therapy. Additionally, the therapeutic efficacy of a) prevention with either calcium 500 mg/day and vitamin D 1000U/day or b) treatment with intermittent cyclical etidronate (400 mg/day for 14 days followed by 500 mg calcium/day for 76 days) was examined prospectively for one year.

Methods Clinical (e.g. rate of fractures, pain intensity), chemical (values of bone mineral metabolism) as well as radiographic parameters (bone mineral density/BMD (DEXA) were measured. Therefore, the patients were divided in two groups: patients with osteopenia (group 1) and patients with osteoporosis or osteopenia and an increased fracture risk (group 2). Patients in group 1 were given with the above-mentioned “prevention regimen”, and those in group 2, the “treatment regimen”.

Results 1. Increasing age was associated with more advanced manifestations of steroid-induced osteoporosis (p < 0.05). Male patients had a risk of steroid-induced osteoporosis, however, this was not statistically significant. Size, weight, daily and cumulative glucocorticoid dose and disease activity showed no significant influence on the degree of osteoporosis. 2. Despite the osteoporosis prevention regime, a significant rise of bone mineral metabolism parameters (pyridinoline, deoxypyridinoline, n-terminal telopeptid, ostase, bone specific alkaline phosphatase) was observed. The BMD was not influenced by therapy. 3. During the etidronate therapy, a significant rise (p < 0.05) in BMD was measured in the lumbar spine, whereas the femoral neck BMD and bone metabolism parameters remained constant. 4. The intensity of back pain was lowered significantly (p < 0.05) in both groups. 5. One year after therapy begin, there were less fractures in group 2 than in group 1.

Conclusion The early treatment with biphosphonates appears effective in long-term glucocorticoid therapy for early osteoporosis and should be recommended.