Glucocorticoids And Osteoporosis

Glucocorticoids are widely used in a range of medical specialities, often long term, and a major side effect is an adverse impact on bone, induced osteoporosis and increased risk of fracture. Glucocorticoid-induced osteoporosis is the most frequent cause of secondary osteoporosis, but the marked variation in susceptibility between individuals makes it difficult to predict who will develop skeletal complications with these drugs. Glucocorticoids may exert their effects on the skeleton in many ways. Advances in our knowledge of the cellular and molecular 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. In particular, variation in 11β-HSD isozyme expression and activity may explain individual differences in susceptibility to glucocorticoid-induced osteoporosis. This article reviews recent studies that elucidate the mechanisms of glucocorticoid-induced osteoporosis and the potential basis for differences in individual sensitivity.