If a patient requires long-term steroid therapy for three or more months, what is the recommended prophylaxis for osteoporosis?

Long-term steroid therapy, particularly when administered for three months or longer, is known to increase the risk of osteoporosis significantly due to its effects on bone metabolism. Steroids can lead to decreased bone formation, increased bone resorption, and an overall reduction in bone density.

Bisphosphonates are specifically designed to prevent bone resorption, thereby helping to maintain or improve bone density in patients at high risk for osteoporosis, which includes those on prolonged steroid therapy. These medications work by inhibiting osteoclasts, the cells responsible for bone resorption, and thus provide an effective means of reducing the risk of fractures associated with steroid-induced osteoporosis.

In contrast, while calcium supplements and vitamin D are essential for overall bone health and play supportive roles in maintaining bone density, they are often not sufficient alone as a primary prophylaxis against significant bone loss in patients receiving long-term steroids. Hormone replacement therapy can be beneficial, particularly in postmenopausal women, but its use as a primary prophylactic treatment for osteoporosis in patients on steroids is less common and typically reserved for specific situations or populations. Thus, bisphosphonates represent the most effective and widely recommended treatment for osteoporosis prophylaxis in this context.