ASN Live Update 2010: Osteoporosis, steroid induced and CKD

Bones and Nephrologists
Steroid related Osteoporosis , Mary Leonard , MD
Take Home Points
1. Steroid induced osteoporosis is 2nd most common cause of osteoporosis
2. Steroids uncouple bone formation and reabsorption
3. They increase osteoclast apoptosis
4. Besides other known risk factors, kidney associated risk factors are microalbuminuria and proteinuria, medications like CNI.
5. Vitamin D is albumin bound and in nephritic syndrome, there is Vitamin D loss.  Usually in NS, the 250H levels are low, this is temporary as pth levels don’t really rise as much based on studies compared to true Vitamin D deficiency.  
6. FRAX program online is a good tool to assess risk for fractures.  Age, gender, BMI, prior fracture, smoking and other factors are all entertained.
7. Recent ACR 2010 guidelines say that Steroid induced osteoporosis can be divided into three categories based on FRAX scores, <10% low risk, 10-20% is mod risk and rest high risk.
8. Bisphosphanates work best for steroid induced osteoporosis. Data on Forteo is new and can be better than bisphosphanates.