Molecular mechanisms of glucocorticoid-induced osteoporosis

Dental extractions and bisphosphonates: the assessment, consent and management, a proposed algorithm

“…13 These include: i) suppression of sex hormones which normally have an inhibitory effect on osteoclasts; ii) direct suppression of osteoblast function; iii) induction of apoptosis of osteoclasts, osteoblasts and osteocytes; iv) increase of effect of parathyroid hormone; and v) increase of the bio-availability of bisphosphonates. 14 Combine these with the suppression of infl ammatory and immune mechanisms by corticosteroids and they could well explain why corticosteroids are emerging as a signifi cant co-risk factor in the development of BONJ.…”

“…13 The potency of any inhaled corticosteroid should also be factored in when considering the total received dose. It may well be prudent at this stage to mention the rheumatoid arthritis group of patients who as yet may not be consistently prescribed bisphosphonates.…”

Corticosteroid use and risk of hip fracture: a population‐based case–control study in Denmark

“…), allergic diseases (asthma and eczema), malignancies and organ transplantation [1]. According to the type of disease and severity of the condition, CS may be administered systemically (oral or injected) or topically (inhaled, dermal or as enemas).…”

“…The prevalence of CS users increased with age: 1.4% of all subjects aged ‡55 years had used CS for more than 3 months [2]. The widespread use may have a major public-health impact because of the risk of adverse events including CS-induced osteoporosis [1,4]. The gravity of this situation is underlined by the fact that few patients use other drugs that may prevent the detrimental effects of CS [5,6].…”

“…Corticosteroids affect bone metabolism by: (i) decreasing bone remodelling and repair of microdamage through impairment of osteocyte, osteoblast and osteoclast function; (ii) inducing a negative calcium balance by increasing renal calcium elimination and inhibiting intestinal calcium absorption; (iii) antagonizing gonadal function; and (iv) affecting parathyroid hormone (PTH) and vitamin D [1]. These changes will reduce bone mass, weaken the skeletal architecture, reduce the biomechanical competence of the skeleton and increase the risk of fracture [7,8].…”