Understanding and Managing Corticosteroid-Induced Osteoporosis

Alexandra O Kobza,1 Deena Herman,1 Alexandra Papaioannou,2,3 Arthur N Lau,1 Jonathan D Adachi1 1Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, ON, Canada; 2Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada; 3Department...

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Autores principales:	Kobza AO, Herman D, Papaioannou A, Lau AN, Adachi JD
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	glucocorticoid-induced osteoporosis bone mineral density fracture bisphosphonate Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/f27234f7507349aa9ed3e103807626a4
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spelling	oai:doaj.org-article:f27234f7507349aa9ed3e103807626a42021-12-02T16:32:14ZUnderstanding and Managing Corticosteroid-Induced Osteoporosis1179-156Xhttps://doaj.org/article/f27234f7507349aa9ed3e103807626a42021-07-01T00:00:00Zhttps://www.dovepress.com/understanding-and-managing-corticosteroid-induced-osteoporosis-peer-reviewed-fulltext-article-OARRRhttps://doaj.org/toc/1179-156XAlexandra O Kobza,1 Deena Herman,1 Alexandra Papaioannou,2,3 Arthur N Lau,1 Jonathan D Adachi1 1Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, ON, Canada; 2Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada; 3Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, CanadaCorrespondence: Jonathan D Adachi 501-25 Charlton Avenue East, Hamilton, Ontario, L8N 1Y2, CanadaTel +1 905-529-1317Fax +1 905-521-1297Email jd.adachi@sympatico.caAbstract: Glucocorticoids are effective immunosuppressants used in a wide variety of diseases. Their use results in secondary osteoporosis in about 30– 50% of chronic glucocorticoid users. Glucocorticoids cause a rapid decline in bone strength within the first 3– 6 months mostly due to increased bone resorption by osteoclasts. This is followed by a more gradual loss of bone partly due to decreased osteoblastogenesis and osteoblast and osteocyte apoptosis. The loss of bone strength induced by glucocorticoids is not fully captured by bone mineral density measurements. Other tools such as the trabecular bone score and advanced imaging techniques give insight into bone quality; however, these are not used widely in clinical practice. Glucocorticoid-induced osteoporosis should be seen as a widely preventable disease. Currently, only about 15% of chronic glucocorticoid users are receiving optimal care. Glucocorticoids should be prescribed at the lowest dose and shortest duration. All patients should be counselled on lifestyle measures to maintain bone strength including nutrition and weight-bearing exercise. Pharmacological therapy should be considered for all patients at moderate to high risk of fracture as there is evidence for the prevention of bone loss and fractures with a favourable safety profile. Oral bisphosphonates are the current mainstay of therapy, whereas osteoanabolic agents may be considered for those at highest risk of fracture.Keywords: glucocorticoid-induced osteoporosis, bone mineral density, fracture, bisphosphonateKobza AOHerman DPapaioannou ALau ANAdachi JDDove Medical Pressarticleglucocorticoid-induced osteoporosisbone mineral densityfracturebisphosphonateDiseases of the musculoskeletal systemRC925-935ENOpen Access Rheumatology: Research and Reviews, Vol Volume 13, Pp 177-190 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	glucocorticoid-induced osteoporosis bone mineral density fracture bisphosphonate Diseases of the musculoskeletal system RC925-935
spellingShingle	glucocorticoid-induced osteoporosis bone mineral density fracture bisphosphonate Diseases of the musculoskeletal system RC925-935 Kobza AO Herman D Papaioannou A Lau AN Adachi JD Understanding and Managing Corticosteroid-Induced Osteoporosis
description	Alexandra O Kobza,1 Deena Herman,1 Alexandra Papaioannou,2,3 Arthur N Lau,1 Jonathan D Adachi1 1Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, ON, Canada; 2Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada; 3Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, CanadaCorrespondence: Jonathan D Adachi 501-25 Charlton Avenue East, Hamilton, Ontario, L8N 1Y2, CanadaTel +1 905-529-1317Fax +1 905-521-1297Email jd.adachi@sympatico.caAbstract: Glucocorticoids are effective immunosuppressants used in a wide variety of diseases. Their use results in secondary osteoporosis in about 30– 50% of chronic glucocorticoid users. Glucocorticoids cause a rapid decline in bone strength within the first 3– 6 months mostly due to increased bone resorption by osteoclasts. This is followed by a more gradual loss of bone partly due to decreased osteoblastogenesis and osteoblast and osteocyte apoptosis. The loss of bone strength induced by glucocorticoids is not fully captured by bone mineral density measurements. Other tools such as the trabecular bone score and advanced imaging techniques give insight into bone quality; however, these are not used widely in clinical practice. Glucocorticoid-induced osteoporosis should be seen as a widely preventable disease. Currently, only about 15% of chronic glucocorticoid users are receiving optimal care. Glucocorticoids should be prescribed at the lowest dose and shortest duration. All patients should be counselled on lifestyle measures to maintain bone strength including nutrition and weight-bearing exercise. Pharmacological therapy should be considered for all patients at moderate to high risk of fracture as there is evidence for the prevention of bone loss and fractures with a favourable safety profile. Oral bisphosphonates are the current mainstay of therapy, whereas osteoanabolic agents may be considered for those at highest risk of fracture.Keywords: glucocorticoid-induced osteoporosis, bone mineral density, fracture, bisphosphonate
format	article
author	Kobza AO Herman D Papaioannou A Lau AN Adachi JD
author_facet	Kobza AO Herman D Papaioannou A Lau AN Adachi JD
author_sort	Kobza AO
title	Understanding and Managing Corticosteroid-Induced Osteoporosis
title_short	Understanding and Managing Corticosteroid-Induced Osteoporosis
title_full	Understanding and Managing Corticosteroid-Induced Osteoporosis
title_fullStr	Understanding and Managing Corticosteroid-Induced Osteoporosis
title_full_unstemmed	Understanding and Managing Corticosteroid-Induced Osteoporosis
title_sort	understanding and managing corticosteroid-induced osteoporosis
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/f27234f7507349aa9ed3e103807626a4
work_keys_str_mv	AT kobzaao understandingandmanagingcorticosteroidinducedosteoporosis AT hermand understandingandmanagingcorticosteroidinducedosteoporosis AT papaioannoua understandingandmanagingcorticosteroidinducedosteoporosis AT lauan understandingandmanagingcorticosteroidinducedosteoporosis AT adachijd understandingandmanagingcorticosteroidinducedosteoporosis
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Understanding and Managing Corticosteroid-Induced Osteoporosis

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