Bisphosphonates and glucocorticoid-induced osteoporosis: cons

Area of Science:

• Endocrinology
• Bone Biology
• Rheumatology

Background:

• Glucocorticoids (GCs) elevate fracture risk through direct and indirect effects on bone and muscle.
• Glucocorticoid-induced osteoporosis (GIO) involves inhibited bone formation and increased osteocyte apoptosis.
• Changes in bone resorption during GC use are variable.

Purpose of the Study:

• To review the impact of GCs on fracture risk.
• To evaluate preventive and therapeutic strategies for GIO.
• To assess the efficacy and limitations of bisphosphonates and teriparatide in GIO.

Main Methods:

• Literature review of studies on GCs, bone health, and osteoporosis treatments.
• Analysis of mechanisms underlying GC-induced bone loss.
• Comparison of fracture reduction data for bisphosphonates and teriparatide.

Main Results:

• GCs increase both vertebral and nonvertebral fracture risk.
• Bisphosphonates reduce vertebral fractures in the first two years of GC treatment.
• Teriparatide demonstrates greater efficacy in reducing vertebral fractures compared to alendronate.

Conclusions:

• General measures like low GC dose, healthy lifestyle, and supplementation are crucial for fracture prevention.
• Bisphosphonates are a primary choice for short-term (2-year) fracture risk reduction in GIO patients.
• Long-term efficacy and safety of bisphosphonates in GIO require further investigation due to potential negative effects on bone turnover.