Since the original description of Cushing's syndrome, it has been recognized that the prolonged maintenance of supraphysiologic levels of corticosteroids can produce severe bone loss.1,2 Studies of patients with Cushing's syndrome have demonstrated that the great majority (80% to 90%) have greatly decreased bone mass, as determined by radiological and histological criteria.2,3 Moreover, loss of bone mass occurs in a characteristic distribution; more severe osteopenia occurs in skeletal regions, such as the ribs and vertebrae, that have a high content of trabecular bone and less severe changes occur in areas such as the long bones, which are comprised primarily of compact cortical bone.1-3 As a consequence, vertebral compression and rib fractures occur commonly in this disorder.
EFFECTS OF CORTICOSTEROIDS ON BONE
Based on these observations, it is not surprising that prolonged therapeutic administration of supraphysiologic doses of corticosteroids or corticotropin often produces clinically substantial bone loss. Many
Hahn TJ. Corticosteroid-Induced Osteopenia. Arch Intern Med. 1978;138(Suppl_5):882-885. doi:10.1001/archinte.1978.03630300050010