[Glucocorticoid and bone metabolism and disease]

Glucocorticoid (GC) is widely used to treat a variety of inflammatory and allergic diseases and about one million people in Japan are known to take oral GC. GC causes a number of significant side effects and among them osteoporosis and degenerative bone fracture are major complications of GC therapy. GC induces apoptosis of osteoblasts and osteocytes and prolongs lifespan of osteoclast, resulting in severe osteoporosis. However, few physicians are aware of the increased risk of fracture caused by GC. Recent multiple evidence strongly indicates that bisphosphonate is effective for treatment and prophylaxis of GC-induced osteoporosis by improving both quantity and quality of bones, which results in reduction of the proportion of fractures. Recent findings regarding with anti-RANKL antibody and PTH (1-34) teriparatide for GC-induced osteoporosis will be also discussed.