Prevention and Management of Glucocorticoid-Induced Osteoporosis

Introduction:

Glucocorticoids are a class of drugs used to treat some autoimmune illnesses and reduce inflammation in the body. They are specifically used to treat lung diseases like asthma (a chronic illness affecting the lungs' airways) and rheumatic disorders like rheumatoid arthritis (an autoimmune condition that causes joint pain). A prolonged overabundance of glucocorticoids raises the possibility of negative consequences, such as osteoporosis (bones grow weak and brittle) and an elevated risk of fractures due to both early and gradual bone loss.

What Is Glucocorticoid-Induced Osteoporosis?

A class of endogenous hormones and medications known as glucocorticoids primarily function by inhibiting the glucocorticoid receptor to provide anti-inflammatory, immunosuppressive, anti-proliferative, and vasoconstrictive actions.

Glucocorticoids include, for example:

• Triamcinolone.

• Prednisone.

• Methylprednisolone.

• Betamethasone.

• Dexamethasone.

These drugs raise the chance of developing osteoporosis, a disorder marked by brittle, weak bones and bone fractures. It is referred to as glucocorticoid-induced osteoporosis when glucocorticoids cause osteoporosis.

The most prevalent cause of osteoporosis induced by drugs is glucocorticoid-induced osteoporosis. A 30 % to 50 % chance of bone fractures occurs in glucocorticoid-using individuals. Osteoporosis brought on by glucocorticoids typically develops when the hormones are administered by mouth.

What Triggers Glucocorticoid-Induced Osteoporosis?

Following a glucocorticoid for a year or more at the identical dosage may result in sustained loss of bones and more serious effects. During the early stages of usage, rapid bone loss might occur.

There are multiple ways in which glucocorticoids might harm bone.

• They promote the reabsorption of bone.

• They reduce the development of bones.

• They reduce the formation of blood vessels in the bone.

According to studies, oral glucocorticoids have a higher risk of causing glucocorticoid-induced osteoporosis compared to other forms. This means that taking even 2.5 mg of oral Prednisone can raise the possibility of fracture.

What Symptoms Are Associated With Glucocorticoid-Induced Osteoporosis?

In less than six months following commencing glucocorticoid treatment, indications of glucocorticoid-induced osteoporosis may develop. Individuals will experience bone loss, fragility, and an increased risk of developing bone fractures.

Glucocorticoid-induced osteoporosis manifestations may be similar to those of ordinary osteoporosis. Initially, one could not be experiencing any signs at all, or one could develop backache or neck discomfort. As the problem worsens, individuals may become short while acquiring improper spinal alignment, such as a forward-curving spine.

How to Diagnose Glucocorticoid-Induced Osteoporosis?

An assessment of bone mineral density using dual-energy X-ray absorptiometry scans is typically required to detect glucocorticoid-induced osteoporosis. It is necessary for patients to lie down on a surface to be scanned to complete these easy, painless evaluations. On the other hand, doctors advise pregnant women not to undergo mineral density examinations.

What Are Some Strategies to Prevent Glucocorticoid-Induced Osteoporosis?

Some measures to prevent GIOP are as follows:

• Since even those that are believed to be equivalent doses or prolonged inhalation glucocorticoids may trigger loss of bone, the amount and length of glucocorticoid therapy must be as minimal as possible. If feasible, other forms of treatment should be employed.

• If possible, topical therapy is favored over systemic glucocorticoids.

• Educating all patients receiving glucocorticoid medication about the possibility of osteoporosis and fractures, as well as possible preventive actions.

• Good food, consistent physical activity, keeping a healthy weight, quitting smoking, and not drinking alcohol constitute essential lifestyle decisions for everyone, but they are more important for those who are on glucocorticoids.

• Individuals with this illness should refrain from kyphoplasty (a minimally invasive treatment to treat spinal tumors or osteoporosis-related compression fractures in the spine) and vertebroplasty (a minimally invasive technique that involves injecting a slurry of acrylic cement into the broken vertebra) for spinal compression fractures due to the enhanced risk of complications.

• Everyone who takes any kind of glucocorticoids, irrespective of their likelihood of fracture risk, should have a basic laboratory examination to identify additional factors of osteoporosis.

• The assessment of fracture risk using Dual-Energy X-ray Absorptiometry (DEXA), and evaluation of vertebral fractures, dictate treatment decisions in GIOP. Bone mineral density is measured with the aid of DEXA.

• Individuals who are on glucocorticoids must start taking bone-sparing medicines to reduce the possibility of fractures.

• Men and women over 40 who have an exceptionally high fracture risk, as well as postmenopausal women, should take the necessary precautions to prevent GIOP. Preventive interventions should additionally be administered to men and women under 40 who have a greater chance of fractures and who are not yet menopausal.

• A key element of the etiology of GIOP is elevated urine elimination of calcium and reduced calcium absorption in the gastrointestinal tract. The recommendations for osteoporosis recommend a sufficient nutritional calcium intake and an acceptable vitamin D level. Calcium or vitamin D supplements must be utilized if the aforementioned objectives are not met. These steps will assist in lowering the chance of fractures or bone loss in glucocorticoid users.

• For many individuals, calcium and vitamin D supplements alone are not enough, necessitating combination therapy with medications that preserve the bones.

• Drugs that protect the bones aid in GIOP prevention. This comprises Teriparatide, Denosumab, Risedronate, Zoledronate, and Alendronate. In order to avoid bone loss and fractures in patients who are at risk of GIOP, bone-targeted medicine should be started as soon as practical, ideally at the start of glucocorticoid treatment. It might also help to improve the density of bone minerals.

• The major objectives of monitoring in GIOP should be to commit to GIOP preventive and treatment recommendations and reconfirm the likelihood of fractures at each appointment.

How to Manage Glucocorticoid-Induced Osteoporosis?

Numerous strategies and treatments have been studied to address and prevent glucocorticoid-induced osteoporosis. The therapeutic strategies for both genders and the root diseases for which the prescriptions are written are the same, despite the fact that the consumption of glucocorticoids is only a single contributory factor for osteoporosis. The fracture risk is taken into account while choosing a course of treatment.

The most often prescribed drug in GIOP and the first-line treatment in all guidelines is bisphosphonates. Numerous studies have been conducted on preventing and managing GIOP using bisphosphonates. GIOP prophylaxis or therapy with Risedronate, Etidronate, Alendronate, or IV Zoledronic acid has been approved for glucocorticoid patients.

Conclusion:

For individuals who use glucocorticoids for three months or more, glucocorticoid-induced osteoporosis is a serious concern. Osteoporosis can be discovered early on through testing. By switching to a different medicine or reducing the dosage, effects can be minimized. By taking up regular resistance training, raising calcium and vitamin D levels, and forming other healthy behaviors, one can lower the risk. It is essential to maintain contact with a healthcare physician when beginning a regular glucocorticoid program.