title: Glucocorticoid-induced osteoporosis: an update on effects and management.
abstract: Glucocorticoids remain a cornerstone of guideline-based management of persistent asthma and allergic diseases. Glucocorticoid-induced osteoporosis (GIO) is the most common iatrogenic cause of secondary osteoporosis and an issue of concern for physicians treating patients with inhaled or oral glucocorticoids either continuously or intermittently. Patients with GIO experience fragility fractures at better dual-energy x-ray absorptiometry T-scores than those with postmenopausal or age-related osteoporosis. This might be explained, at least in part, by the effects of glucocorticoids not only on osteoclasts but also on osteoblasts and osteocytes. Effective options to detect and manage GIO exist, and a management algorithm has been published by the American College of Rheumatology to provide treatment guidance for clinicians. This review will summarize GIO epidemiology and pathophysiology and assess the role of inhaled and oral glucocorticoids in asthmatic adults and children, with particular emphasis on the effect of such therapies on bone health. Lastly, we will review the American College of Rheumatology GIO guidelines and discuss diagnostic and therapeutic strategies to mitigate the risk of GIO and fragility fractures.
authors.affiliation: University of Wisconsin Osteoporosis Research Program, Division of Geriatrics and Gerontology, University of Wisconsin School of Medicine & Public Health, Madison, Wis; GRECC, William S. Middleton Memorial Veterans Hospital, Madison, Wis. Electronic address: bbuehring@medicine.wisc.edu.
authors.forename: Bjoern
authors.initials: B
authors.lastname: Buehring
authors.forename: Ravi
authors.initials: R
authors.lastname: Viswanathan
authors.forename: Neil
authors.initials: N
authors.lastname: Binkley
authors.forename: William
authors.initials: W
authors.lastname: Busse
mesh_terms: D018927:Anti-Asthmatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001249:Asthma / Q000150:complications / Q000188:drug therapy; D001842:Bone and Bones / Q000033:anatomy & histology / Q000502:physiology; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D010024:Osteoporosis / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D017410:Practice Guidelines as Topic
chemical_list: D018927:Anti-Asthmatic Agents; D005938:Glucocorticoids
keywords: ACR; AFF; ASBMR; American College of Rheumatology; American Society for Bone Mineral Research; Atypical femur fracture; BDP; BMD; Beclomethasone dipropionate; Bone mineral density; CAMP; Childhood Asthma Management Program; DXA; Dual-energy x-ray absorptiometry; FDA; GIO; Glucocorticoid; Glucocorticoid-induced osteoporosis; ICS; Inhaled corticosteroid; LABA; Long-acting β-agonist; OCS; OR; Odds ratio; Oral corticosteroid; US Food and Drug Administration; asthma; bisphosphonates; growth; inhaled and oral corticosteroid; osteoporosis