Glucocorticoids, Inflammation and Bone

The current review on glucocorticoids (GCs), inflammation and bone is focused on three aspects: (1) the mutual effects between GCs, inflammation and bone in inflammatory rheumatic diseases, (2) current views on fracture risk assessment in patients using GCs and (3) non-pharmacological and pharmacolo...

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Bibliographic Details
Published in:Calcified tissue international 2018-05, Vol.102 (5), p.592-606
Main Authors: Güler-Yüksel, Melek, Hoes, Jos N., Bultink, Irene E.M., Lems, Willem F.
Format: Article
Language:English
Subjects:
Biochemistry
Biomedical and Life Sciences
Bone loss
Bone mass
Calcium
Cell Biology
Dietary supplements
Disease prevention
Drug therapy
Endocrinology
Fractures
Glucocorticoids
Inflammation
Inflammatory diseases
Life Sciences
Muscle strength
Orthopedics
Osteoporosis
Review
Rheumatic diseases
Rheumatoid arthritis
Rheumatology
Risk assessment
Vitamin D
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Summary:The current review on glucocorticoids (GCs), inflammation and bone is focused on three aspects: (1) the mutual effects between GCs, inflammation and bone in inflammatory rheumatic diseases, (2) current views on fracture risk assessment in patients using GCs and (3) non-pharmacological and pharmacological treatment to prevent fractures in GC-using patients with inflammatory rheumatic diseases. The use of GCs results in increased risk for fractures due to both direct and indirect negative effects of GCs on bone mass, and on bone and muscle strength. However, also the underlying inflammatory rheumatic disease is associated with the increased bone loss and fracture risk due to the chronic inflammation itself, and due to disability/immobility caused by active disease or joint destruction. The rapid and strong anti-inflammatory effect of GCs in patients with rheumatoid arthritis seems to balance the negative effects of GCs on bone in the early, active phase of the disease. Recently, an update of the American College of Rheumatology guidelines for prevention and treatment of GC-induced osteoporosis was published with renewed recommendations. To prevent fractures, general measures, including treatment of the underlying inflammatory disease adequately (even with GCs when indicated), a healthy lifestyle, including adequate calcium and vitamin D supplementation, and regular weight bearing exercises are important. In rheumatic patients with high fracture risk using GCs, especially when the cumulative dose is high and/or the underlying inflammatory disease is active, treatment with anti-osteoporotic drugs, usually an oral bisphosphonate, is indicated.
ISSN:0171-967X
1432-0827
DOI:10.1007/s00223-017-0335-7