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Glucocorticoid-induced osteoporosis: an overview with focus on its prevention and management

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Abstract

The widespread use of glucocorticoids (GCs) contributes to the effective management of several diseases and conditions. However, it comes at a price in the case of the bones causing glucocorticoid-induced osteoporosis (GIOP), the most common cause of secondary osteoporosis and fractures. Several scientific societies have issued comprehensive guidelines on the optimal management of patients receiving GCs with the aim of providing answers to three fundamental questions, namely, whom to treat, when to treat, and how to treat. Both common ground and different approaches exist among them. General preventive measures should start along with GC initiation, and the duration of GC therapy should be limited to the minimal effective range. A pre-existing fracture, age, gender, menopausal status, dose, and duration of GC treatment are key factors in the decision to initiate antiosteoporotic medication. Oral bisphosphonates are typically regarded as the first-line treatment choice for GIOP partly due to their cost-effectiveness. Denosumab is another valid option, but an “exit strategy” should be considered before its initiation due to the risk of rebound-associated vertebral fractures upon its discontinuation. Since impaired bone formation represents the main mechanism by which GCs negatively affect skeletal health, osteoanabolic therapies appear to be pathophysiologically the more appropriate and appealing option, although cost considerations currently limit their use to selected severe cases. Regardless of the agent selected to mitigate the impact of GCs on the skeleton, what is most crucial is that the treating physician correctly stratifies the risk and intervenes at the right time.

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Authors and Affiliations

  1. School of Medicine, European University of Cyprus, Nicosia, Cyprus

    Eleni Anastasilaki

  2. Univ. Lille, CHU Lille, MABlab ULR 4490, Department of Rheumatology, 59000, Lille, France

    Julien Paccou

  3. Deparment of Endocrinology and Diabetes, St Luke’s Hospital, Thessaloniki, Greece

    Konstantinos Gkastaris

  4. Department of Endocrinology, 424 Military General Hospital, Ring Road, 564 29 N. Efkarpia, Thessaloniki, Greece

    Athanasios D. Anastasilakis

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Conception of the hypothesis of the study: ADA. Design of the study: ADA and JP. Acquisition, analysis, and interpretation of data: EA, JP, KG, and ADA. Drafting of the manuscript: EA and ADA. Revision of the work critically for important intellectual content: JP and KG. Final approval of the submitted version: EA, JP, KG, and ADA. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: EA, JP, KG, and ADA.

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Anastasilaki, E., Paccou, J., Gkastaris, K. et al. Glucocorticoid-induced osteoporosis: an overview with focus on its prevention and management. Hormones 22, 611–622 (2023). https://doi.org/10.1007/s42000-023-00491-1

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