Glucocorticoid induced osteoporosis

ABSTRACT

Introduction: Glucocorticoid-induced osteoporosis is the most common secondary cause of osteoporosis. Despite this, many patients receiving glucocorticoids are not evaluated for their skeletal health.

Areas covered: Glucocorticoids have profound effects on bone cells, resulting in increases in bone resorption and impairments in bone formation. Bone loss and subsequent increases in fracture risk occur early after the administration of glucocorticoids. Incidence of fractures is highest within the first 6 months of glucocorticoid treatment, and declines with longer exposure. Decreases in bone mass follow a dose-dependent relationship with glucocorticoid dosage. Pharmacologic prevention and treatment for osteoporosis are recommended for all patients receiving glucocorticoids. Oral bisphosphonates, with concomitant vitamin D and calcium supplementation, are considered as the first-line treatment option. However, a number of alternative treatment options, including intravenous bisphosphonates, anabolic agents, and denosumab have all proven efficacy in increasing lumbar spine or hip bone mineral density. The mechanism of action and recent controlled trials for these therapies are reviewed. The literature search was conducted within PubMed in November 2018. 492 articles were found and 45 were included.

Expert opinion: Future studies will likely evaluate the safety profiles of alternative treatments, while focusing on its ability to reduce fracture risk.

KEYWORDS:

• Glucocorticoid
• osteoporosis
• bisphosphonate
• denosumab
• teriparatide

Article highlights

• Glucocorticoid-induced osteoporosis is the most common secondary form of osteoporosis.

• Glucocorticoids have profound effects on bone cells, ultimately resulting in increased bone resorption and diminished bone formation.

• Osteoporotic and fracture risk substantially depends on duration of glucocorticoid therapy, as well as the steroid dosage.

• Oral bisphosphonates, coupled with vitamin D and calcium supplements, are recommended as treatment for those with GIO.

• For those who are intolerant to oral bisphosphonates, a number of alternatives exist that have proven efficacy in increasing bone mineral density.

• Trials evaluating intravenous bisphosphonates, denosumab, and teriparatide have all shown promising results. However, due to high-risk factors or high cost, these alternatives are not always recommended.

Declaration of interest

J D Adachi has participated in clinical trials involving alendronate, risedronate, zoledronic acid, and denosumab and in the past have received funding from Merck, Procter& Gamble, Sanofi, Novartis, and Amgen. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.