Introduction: Endogenous or exogenous (corticosteroid-induced) glucocorticoids (GCs) excess represents, together with diabetes, the most common cause of secondary osteoporosis. Areas covered: We present a comprehensive overview about the pathophysiology, clinical management and treatment of GCs induced osteoporosis (GIOP). According to PRISMA guidelines, a literature search identifying articles about bone and GCs was done. Expert opinion: Despite the progress over the years and the increase in therapeutic options, there still are controversial issues about the management of GIOP. These mainly include the failure of BMD or FRAX to completely account for the rapid increase in fracture risk of most GC-treated patients, the understanding about the independent contribution on bone fragility of the underlying disease requiring GCs therapy, and the necessity of clearer information about the anti-fracture efficacy and long term-safety of most therapeutic options. Moreover, there are no specific indications for the management of bone fragility in endogenous hypercortisolism. Notwithstanding the above limitations there is a general consensus to recommend an assessment of fracture risk in all individuals >40 years committed to receive (or continuing) high dose (>7.5 mg of prednisone equivalent) GCs for ≥3 months and in all patients with fragility fracture history.

Updates in epidemiology, pathophysiology and management strategies of glucocorticoid-induced osteoporosis / I. Chiodini, A. Falchetti, D. Merlotti, C. Eller Vainicher, L. Gennari. - In: EXPERT REVIEW OF ENDOCRINOLOGY & METABOLISM. - ISSN 1744-6651. - 15:4(2020), pp. 283-298.

Updates in epidemiology, pathophysiology and management strategies of glucocorticoid-induced osteoporosis

I. Chiodini
Primo
;
C. Eller Vainicher
Penultimo
;
2020

Abstract

Introduction: Endogenous or exogenous (corticosteroid-induced) glucocorticoids (GCs) excess represents, together with diabetes, the most common cause of secondary osteoporosis. Areas covered: We present a comprehensive overview about the pathophysiology, clinical management and treatment of GCs induced osteoporosis (GIOP). According to PRISMA guidelines, a literature search identifying articles about bone and GCs was done. Expert opinion: Despite the progress over the years and the increase in therapeutic options, there still are controversial issues about the management of GIOP. These mainly include the failure of BMD or FRAX to completely account for the rapid increase in fracture risk of most GC-treated patients, the understanding about the independent contribution on bone fragility of the underlying disease requiring GCs therapy, and the necessity of clearer information about the anti-fracture efficacy and long term-safety of most therapeutic options. Moreover, there are no specific indications for the management of bone fragility in endogenous hypercortisolism. Notwithstanding the above limitations there is a general consensus to recommend an assessment of fracture risk in all individuals >40 years committed to receive (or continuing) high dose (>7.5 mg of prednisone equivalent) GCs for ≥3 months and in all patients with fragility fracture history.
Bisphosphonates; Cushing disease; denosumab; fracture; glucocorticoids; osteoporosis; subclinical hypercortisolism; teriparatide
Settore MED/13 - Endocrinologia
25-giu-2020
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/747032
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