Glucocorticoid-induced osteoporosis : pathophysiology and therapy

• Published in: Osteoporosis international Vol. 18; no. 10; pp. 1319 - 1328
• Main Authors: CANALIS, E, MAZZIOTTI, G, GIUSTINA, A, BILEZIKIAN, J. P
• Format: Journal Article
• Language: English
• Published: London Springer 01-10-2007; Springer Nature B.V
• Subjects: Biological and medical sciences; Bone Density; Diseases of the osteoarticular system; Drug toxicity and drugs side effects treatment; Female; Fractures; Fractures, Bone - chemically induced; Fractures, Bone - physiopathology; Fractures, Bone - therapy; Glucocorticoids - adverse effects; Guideline Adherence; Humans; Male; Medical sciences; Osteoblasts - drug effects; Osteocytes - drug effects; Osteoporosis; Osteoporosis - chemically induced; Osteoporosis - therapy; Osteoporosis. Osteomalacia. Paget disease; Pharmacology. Drug treatments; Steroids; Toxicity: osteoarticular system; Treatment Outcome; Vitamin D - therapeutic use; Human; Glucocorticoid-induced osteoporosis; Pathophysiology; Pathogenesis; Toxicity; Diseases of the osteoarticular system; Vertebra; Fracture; Trauma; Glucocorticoid; Osteoporosis; Chronic; Treatment; Fractures; Bone mineral density; Skeleton; Bone
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-007-0394-0

Glucocorticoid-induced osteoporosis (GIO) is the most common form of secondary osteoporosis. Fractures, which are often asymptomatic, may occur in as many as 30-50% of patients receiving chronic glucocorticoid therapy. Vertebral fractures occur early after exposure to glucocorticoids, at a time when bone mineral density (BMD) declines rapidly. Fractures tend to occur at higher BMD levels than in women with postmenopausal osteoporosis. In human subjects, the early rapid decline in BMD is followed by a slower progressive decline in BMD. Glucocorticoids have direct and indirect effects on the skeleton. The primary effects are on osteoblasts and osteocytes. Glucocorticoids impair the replication, differentiation and function of osteoblasts and induce the apoptosis of mature osteoblasts and osteocytes. These effects lead to a suppression of bone formation, a central feature in the pathogenesis of GIO. Glucocorticoids also favor osteoclastogenesis and as a consequence increase bone resorption. Bisphosphonates are effective in the prevention and treatment of GIO. Anabolic therapeutic strategies are under investigation.