An update on glucocorticoid-induced osteoporosis.
OBJECTIVE
Glucocorticoids are widely used, often long term, and a major side effect is osteoporosis and increased risk of fracture. This review considers how common is the problem, the patients who are most at risk, our current understanding of mechanisms, and how to prevent and effectively treat glucocorticoid-induced osteoporosis. The actions currently being undertaken in clinical practice are reviewed.


RESULTS
Glucocorticoid-induced osteoporosis is an increasing problem that occurs not only in those on high-dose therapy. Advances in our knowledge of the cellular and cytokine mechanisms of bone turnover and glucocorticoid mechanisms of action are leading to a better understanding of how glucocorticoids affect bone cells and novel ways of prevention. Although there are effective treatments to prevent and control glucocorticoid-induced osteoporosis as well as guidelines for their use, they are still not being applied in routine clinical practice.


CONCLUSIONS
Glucocorticoid-induced osteoporosis is a significant problem. Although our understanding of effective prevention and treatment strategies is improving, there needs to be better implementation of these strategies.
Woolf
Anthony D
AD
Institute of Health and Social Care Research, Peninsula Medical School, Universities of Exeter and Plymouth and Duchess of Cornwall Centre for Osteoporosis, Department of Rheumatology, Royal Cornwall Hospital, Truro, UK. anthony.woolf@btopenworld.com
D015519:Bone Density / Q000187:drug effects* / Q000502:physiology; D016723:Bone Remodeling / Q000187:drug effects* / Q000502:physiology; D004305:Dose-Response Relationship, Drug; D050723:Fractures, Bone / Q000139:chemically induced* / Q000503:physiopathology / Q000517:prevention & control; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D010024:Osteoporosis / Q000139:chemically induced* / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D012307:Risk Factors
D005938:Glucocorticoids