, Volume 18, Issue 10, pp 1319-1328

Glucocorticoid-induced osteoporosis: pathophysiology and therapy

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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.

This work was supported by Grant AR21707 (E. Canalis) from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, Grants DK42424 and DK45227 (E. Canalis), and DK32333 (J.P. Bilezikian) from the National Institute of Diabetes & Digestive & Kidney Diseases and by MIUR and Centro di Ricerca sull’Osteoporosi-University of Brescia/EULO (A. Giustina).