Osteoporosis International

, Volume 18, Issue 10, pp 1319–1328

Glucocorticoid-induced osteoporosis: pathophysiology and therapy

  • E. Canalis
  • G. Mazziotti
  • A. Giustina
  • J. P. Bilezikian
Review

DOI: 10.1007/s00198-007-0394-0

Cite this article as:
Canalis, E., Mazziotti, G., Giustina, A. et al. Osteoporos Int (2007) 18: 1319. doi:10.1007/s00198-007-0394-0

Abstract

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.

Keywords

Bone mineral densityFracturesGlucocorticoid-induced osteoporosis

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2007

Authors and Affiliations

  • E. Canalis
    • 1
    • 2
  • G. Mazziotti
    • 3
  • A. Giustina
    • 3
  • J. P. Bilezikian
    • 4
  1. 1.Saint Francis Hospital and Medical CenterHartfordUSA
  2. 2.University of Connecticut School of MedicineFarmingtonUSA
  3. 3.Department of Internal MedicineUniversity of BresciaBresciaItaly
  4. 4.Department of Medicine, College of Physicians and SurgeonsColumbia UniversityNew YorkUSA