Effect of systemic glucocorticoid therapy on bone metabolism: an update

Glucocorticoids are widely used for a range of inflammatory conditions. However, their use is complicated by significant side effects. The most important of these from a clinical point of view is on bone, where glucocorticoids substantially increase the risk of osteoporosis and fracture. This review will give an overview of the pathophysiologic basis and epidemiology of glucocorticoid-induced osteoporosis, examine diagnostic and therapeutic approaches currently available, and suggest the likely impact of the most recent scientific, clinical and pharmaceutical advances. Glucocorticoids impact on both bone formation and bone resorption, a combination that leads to rapid bone loss and increase in fracture risk. Epidemiologic studies indicate that these risks are substantial, especially at the spine, increase with age and independently of bone density, and are maintained during glucocorticoid use. The best available treatments are bisphosphonates that preserve bone density and reduce the risk of fracture at the spine. Future areas that need to be addressed are the relationship between inflammation and the action of glucocorticoids on the skeleton, and the development of anabolic therapies for glucocorticoid-induced osteoporosis.