Glucocorticoid‐induced osteoporosis: lessons from C ushing's syndrome
Abstract
Summary: Glucocorticoid‐induced osteoporosis (GIO) is the most frequent form of secondary bone disorders. Most of our knowledge on its pathogenesis and treatment has been obtained by investigating patients treated with exogenous glucocorticoids. This review will focus on the bone disorder in endogenous C ushing's syndrome, updating recent advances in its pathophysiology, diagnostic aspects and the various predictors which are important in determining bone mineral density (BMD) and fracture risk. We now know strong evidence that beside BMD, bone microarchitecture, one of the most important elements of bone quality, is a key factor in determining fracture risk. Recently, two new methods (spinal deformity index and trabecular bone score) have been shown to be useful markers of bone microarchitecture in GIO. Investigations of GIO in endogenous C ushing's syndrome have also contributed to our understanding on its natural history and reversibility. Relying on recently published guidelines for management of exogenous GIO, a short list of suggestions is provided regarding the optimal diagnostic and therapeutic approach to patients with endogenous GIO.
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The trabecular bone score has been introduced as a method of bone quality estimation in glucocorticoid-induced osteoporosis.
“The trabecular bone score (TBS) has been recently introduced as a method of bone quality estimation in GIO [10, 15].”
From Pituitary Disorders and Osteoporosis (2015) · cites this paper as [10]
In both endogenous and exogenous hypercortisolism, fractures may be asymptomatic and occur in patients with normal or only slightly decreased BMD values.
“In both endogenous and exogenous hypercortisolism fractures might be asymptomatic and occur in patients with normal or only slightly decreased BMD values [3, 10, 12].”
From Pituitary Disorders and Osteoporosis (2015) · cites this paper as [10]
DXA is considered a gold-standard measurement of BMD, but it cannot assess bone microarchitecture, the most important factor in determining bone quality.
“Although dual-energy X-ray absorptiometry (DXA) is considered a gold-standard measurement of BMD, it cannot be employed to assess bone microarchitecture, the most important factor in determining bone quality [10, 14].”
From Pituitary Disorders and Osteoporosis (2015) · cites this paper as [10]
In patients with endogenous Cushing's syndrome, fractures occur most commonly at the thoracic and lumbar vertebrae, hip, ribs, and pelvis, often spontaneously or after low-energy trauma.
“In patients with endogenous Cushing's syndrome fractures occur most commonly at the thoracic and lumbar vertebrae, hip, ribs, and pelvis, not infrequently developing spontaneously or after low-energy trauma [10].”
From Pituitary Disorders and Osteoporosis (2015) · cites this paper as [10]
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Treatment of Cushing's syndrome: an Endocrine Society clinical practice guideline
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Pituitary Disorders and Osteoporosis
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- Authors
- Tóth, M., & Grossman, A.
- Affiliations
- Semmelweis University (HU)
- University of Oxford (GB)
- Corresponding author
- Tóth, Miklós
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2013-04-13
- Volume
- 79
- Issue
- 1
- Pages
- 1-11
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W1966056170
- Cited by
- 81
- References
- 8
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 3 · 2023: 3 · 2022: 8 · 2021: 4 · 2020: 9 · 2019: 5 · 2018: 7 · 2017: 6 · 2016: 4 · 2015: 12 · 2014: 9 · 2013: 1
- FWCI
- 1.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Army Research Office
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- glucocorticoid-induced osteoporosis, Cushing's syndrome, bone mineral density, fracture risk, bone microarchitecture, trabecular bone score, pathophysiology, diagnosis, treatment, reversibility
- MeSH terms
- Bone and Bones, Cushing Syndrome, Glucocorticoids, Humans, Osteoporosis, Risk Factors, Bone Density, Risk Assessment, Bone Density Conservation Agents
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