Guidelines for Safe Corticosteroid Use in Elderly Patients

Key Principles for Corticosteroid Use

The American Gastroenterological Association recommends that corticosteroid therapy choices should not be delayed when clinically indicated, but prolonged use should be avoided due to increased risk of adverse effects in elderly patients 1, 2
Budesonide formulations are preferred over conventional systemic corticosteroids in elderly patients when appropriate for the condition, such as for ileocolonic or right-sided luminal Crohn's disease or left-sided ulcerative colitis 1
For localized conditions, topical formulations should be considered before systemic therapy, and when topical corticosteroids are needed for distal colonic disease, formulations with lower volume may be preferred in older patients with limited mobility or weak sphincter tone 1

Regular assessment for hypertension, hyperglycemia, sleep and mood disturbances, gastric irritation, glaucoma, myopathy, and osteoporosis is recommended for elderly patients on corticosteroids 3, 4
Assessment of hepatic and renal function before initiation of therapy is necessary for elderly patients 1

The American College of Rheumatology conditionally recommends PTH/PTHrP over anti-resorptive agents for adults ≥40 years at very high fracture risk due to high-dose corticosteroid therapy or cumulative dose ≥5 g over 1 year 5, 6
Oral bisphosphonates are strongly recommended over no treatment for osteoporosis prevention in high-risk elderly patients 5
Any use of systemic corticosteroids should prompt consideration for measures to mitigate risk for osteoporosis, such as dietary modifications and corticosteroid-sparing therapy 1
Consider proton pump inhibitor or misoprostol for gastrointestinal protection in elderly patients on corticosteroids, especially if combined with NSAIDs 7

Systemic corticosteroids should not be used for maintenance therapy in inflammatory bowel disease (IBD) in elderly patients, and corticosteroid use for IBD maintenance therapy should be avoided due to potentially higher risk of adverse effects 1, 2
Budesonide may be preferred over conventional corticosteroids for specific IBD presentations in older patients 1