Introduction:
Glucocorticoids are powerful drugs that fight inflammation and work with the immune system to treat a variety of health problems. The body actually makes its own glucocorticoids. These hormones have many roles in regulating how cells use sugar and fat to reduce inflammation.
Glucocorticoids prevent the body from releasing many of the chemicals involved in inflammation. They may also inhibit the immune system's response by altering the way white blood cells work. Osteoporosis is a condition leading to weak and brittle bones. The bones are so fragile that even light movements such as falling or bending over, or coughing can cause fractures. Osteoporosis-induced fractures commonly occur in the hip, wrist, or spine. Bone is a type of living tissue that is constantly being renewed.
What Is Glucocorticoid-Induced Osteoporosis?
Glucocorticoid drugs have direct and indirect effects on bone tissue, leading to bone loss. These drugs have a direct adverse effect on bone cells, slowing the rate of new bone formation. It can also affect how the body uses calcium and levels of sex hormones. Any of these problems can lead to increased bone loss. People who take glucocorticoid drugs and have other risk factors for osteoporosis develop glucocorticoid-induced osteoporosis and have an elevated risk of suffering fractures (fractures). Some of these risk factors can be avoided, but others cannot.
What Are the Risk Factors for Glucocorticoid-Induced Osteoporosis?
Major risk factors are listed below:
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Older age or children.
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Non-Hispanic white or Asian.
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Small bone structure.
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Family history of osteoporosis in parents or siblings.
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Prior fracture due to a low-level injury after age 50.
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Low levels of sex hormones, such as low estrogen levels in women (menopause).
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Anorexia nervosa (eating disorder).
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Cigarette smoking.
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Alcohol intake.
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Low calcium and vitamin D levels.
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Inactive lifestyle or immobility.
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Certain medications besides glucocorticoids, including the following:
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Excess replacement of thyroid hormone.
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Heparin (blood thinner).
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Prostate cancer treatment (e.g., Lupron) or breast cancer treatment (Arimidex, Femara, etc.) that reduces sex hormone levels.
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A disease affecting the bones.
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Hormone diseases such as hyperthyroidism, Cushing's disease, and hyperparathyroidism.
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Inflammatory arthritis like rheumatoid arthritis.
What Are the Symptoms of Glucocorticoid-Induced Osteoporosis?
There are usually no symptoms in the early stages of bone loss. However, when osteoporosis weakens the bones, the following signs and symptoms may occur:
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Back pain due to broken or crushed vertebrae.
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Height loss over time.
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Stooped posture.
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Bones that break easily.
How Is Glucocorticoid-Induced Osteoporosis Diagnosed?
A simple test that measures bone mineral density (BMD) can tell if a person has osteoporosis. BMD is the percentage of bone levels in a particular area which is measured in different parts of the body. Measurements are often taken from the spine and hips, including the part of the lower back called the femoral neck, located at the top of the femur (thigh bone). Dual-energy X-ray absorptiometry (DEXA scan) is currently the best test for measuring BMD. The test is quick and painless. Similar to X-rays but uses much less radiation. However, pregnant women should not have this test to avoid the risk of harm to the fetus. A bone mineral density score of -2.5 or lower is considered osteoporosis. The risk of fractures is usually lower in people with osteopenia than in people with osteoporosis. However, continued bone loss increases the risk of fractures. However, people taking glucocorticoids appear to be at higher risk of fractures with higher-than-expected bone density.
What Is the Treatment of Glucocorticoid-Induced Osteoporosis?
The treatment of glucocorticoid-induced osteoporosis is done in the ways listed below:
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As specialists in diagnosing and treating diseases of the joints, muscles, and bones, rheumatologists can help find the cause of osteoporosis. They can provide the best treatment for this condition and monitor it.
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Anyone taking glucocorticoid medications should get enough calcium and vitamin D. The American College of Rheumatology recommends at least 1,200 mg of calcium and 800 to 1,000 International Units (IU) of vitamin D supplements daily. The doctor can measure the vitamin D levels in the blood to determine if one needs additional vitamin D supplements.
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The decision to start prescription medications depends on other risk factors, the dose and duration of glucocorticoid medications a person is taking, and the results of his BMD by DEXA. The U.S. Food and Drug Administration (also known as the FDA) has approved certain medications to prevent and treat glucocorticoid-induced osteoporosis.
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A class of drugs called bisphosphonates, Alendronate, Risedronate, and Zoledronic acid are FDA-approved for both the prevention and treatment of glucocorticoid-induced osteoporosis. Another class of drugs, Teriparatide, is also approved for treating glucocorticoid-induced osteoporosis. This synthetic form of parathyroid hormone helps stimulate bone formation. Women who plan to become pregnant should discuss the pros and cons of using bisphosphonates or Teriparatide with their doctor.
How to Prevent Glucocorticoid-Induced Osteoporosis?
Patients taking glucocorticoid drugs should take the following precautions:
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In the case of glucocorticoid medication intake for a long duration, one should start taking calcium and vitamin D supplements at the doses recommended by the doctor.
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Use of minimal doses of glucocorticoids so that the disease can be controlled.
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Move and engage in weight-bearing exercises, such as walking, most days of the week.
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Make lifestyle changes that reduce the risk of osteoporosis.
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No smoking.
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Implement strategies to reduce the risk of falls that increase the risk of fractures.
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Get the regular DEXA scans for BMD.
Conclusion
In case a person has low bone density and a high risk of fractures, their doctor may recommend drugs to keep their bones from weakening. Healthcare providers now have tools to estimate a patient's risk of osteoporosis-related fractures over the next decade. There is a World Health Organization fracture risk assessment tool, also called FRAX, that helps make treatment decisions. The most serious health consequences of any type of osteoporosis are fractures. Spine and hip fractures, in particular, can lead to chronic pain, long-term disability, and even death. The main goal of treatment for glucocorticoid-induced osteoporosis is to prevent fractures. With timely intervention, this condition can be easily managed.
