Pathogenesis of glucocorticoid-induced osteoporosis and options for treatment
Abstract
Glucocorticoids are widely used to suppress inflammation or the immune system. High doses and long-term use of glucocorticoids lead to an important and common iatrogenic complication, glucocorticoid-induced osteoporosis, in a substantial proportion of patients. Glucocorticoids mainly increase bone resorption during the initial phase (the first year of treatment) by enhancing the differentiation and maturation of osteoclasts. Glucocorticoids also inhibit osteoblastogenesis and promote apoptosis of osteoblasts and osteocytes, resulting in decreased bone formation during long-term use. Several indirect effects of glucocorticoids on bone metabolism, such as suppression of production of insulin-like growth factor 1 or growth hormone, are involved in the pathogenesis of glucocorticoid-induced osteoporosis. Fracture risk assessment for all patients with long-term use of oral glucocorticoids is required. Non-pharmacological interventions to manage the risk of fracture should be prescribed to all patients, while pharmacological management is reserved for patients who have increased fracture risk. Various treatment options can be used, ranging from bisphosphonates to denosumab, as well as teriparatide. Finally, appropriate monitoring during treatment is also important.
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Sex matching is essential since human male/female differences have been found in total brain volume, gray matter brain volume in specific regions and brain connectivity; sexual dimorphism of the brain has also been found during childhood.
“Moreover, sex matching is essential since human male/female differences have been found in total brain volume (697), gray matter brain volume in specific regions (698) and brain connectivity (699); sexual dimorphism of the brain has also been found during childhood (700)(reviewed in (689)).”
From Congenital Adrenal Hyperplasia—Current Insights in Pathophysiology, Diagnostics, and Management (2022) · cites this paper as [700]
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- Authors
- Chotiyarnwong, P., & McCloskey, E. V.
- Affiliations
- Siriraj Hospital (TH)
- University of Sheffield (GB)
- Corresponding author
- McCloskey, Eugene V.
- Venue
- Nature Reviews Endocrinology
- Published
- 2020-04-14
- Volume
- 16
- Issue
- 8
- Pages
- 437-447
- ISSN
- 1759-5029 (ISSN-L)
- 1759-5037
- OpenAlex
- W3015204213
- Cited by
- 489
- References
- 10
- Citations by year
- 2026: 57 · 2025: 92 · 2024: 101 · 2023: 82 · 2022: 85 · 2021: 62 · 2020: 8 · 2015: 2
- FWCI
- 11.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Nature Reviews Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Bone Metabolism and Diseases
- Health Sciences › Medicine › Oncology › Bone health and treatments
- Keywords
- glucocorticoid-induced osteoporosis, glucocorticoids, bone resorption, osteoclastogenesis, osteoblast apoptosis, osteoblastogenesis, insulin-like growth factor I, growth hormone, fracture risk assessment, bisphosphonates, denosumab, teriparatide, bone metabolism
- MeSH terms
- Bone and Bones, Bone Resorption, Female, Glucocorticoids, Humans, Male, Middle Aged, Osteoblasts, Osteoclasts, Osteocytes, Osteoporosis, Apoptosis, Postmenopause, Risk Assessment, Fractures, Bone, Osteoporotic Fractures
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