Clinical Study Corticosteroid-induced osteoporosis in patients with uveitis
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N P Jones1, L C Anderton1, F M Cheong2, A Whallett3, M R Stanford2, P I Murray3,
S Lesnik-Oberstein4 and C Pavesio4
1The Royal Eye Hospital Manchester, UK
2St Thomas' Hospital London, UK
3Birmingham & Midland Eye Centre Birmingham, UK
4Moorfields Eye Hospital London, UK
Correspondence to: N P Jones, Consultant Ophthalmic Surgeon Manchester Royal Eye
Hospital Oxford Road Manchester M13 9WH, UK Tel: 0161 276 5628 Fax: 0161 272
6618 E-mail: njones@central.cmht.nwest.nhs.uk
Abstract
Aims To estimate the prevalence of low bone density and osteoporosis in a
population of patients with uveitis taking systemic steroid treatment; to
clarify the risks of steroid-induced fracture and to suggest a protocol for the
prevention and management of bone loss in patients with ophthalmic inflammatory
disease.
Methods Bone densitometry was performed on 129 adult patients with prednisolone-treated
uveitis from four centres. Information on uveitis diagnosis, associated risk
factors, steroid dosage and treatment duration, prophylaxis and management, was
collected. Juveniles, patients with scleritis and those who had used deflazacort,
were excluded.
Results Steroid treatment time varied from 13 weeks to 31 years, and the total
dosage from 1.29 g to 166.5 g. Twenty-six percent of patients also used one or
more immunosuppressives. Forty-eight percent had additional risk factors for
bone loss. Bone density was abnormally low in 44.2%, and 15.5% had osteoporosis.
Osteoporosis was substantially more common in males (20.6%, all under 60 yrs)
than in females (9.8%). Seven symptomatic fractures occurred in patients on
treatment. Bone loss correlated with total steroid dose, mean dose, duration of
treatment and the presence of pre-existing risk factors.
Conclusions The prevalence of steroid-induced osteoporosis and fracture is low
for patients with uveitis but young males are at risk. Patients at high risk
should be identified, and prophylaxis and treatment should be used as required.
The guideline of the National Osteoporosis Society is recommended as a
management protocol.
Eye (2002) 16, 587-593. doi:10.1038/sj.eye.6700163
Keywords
uveitis; ocular inflammatory disease; corticosteroids; bone densitometry;
osteopenia; osteoporosis; fracture
