TY - JOUR
T1 - Updates in epidemiology, pathophysiology and management strategies of glucocorticoid-induced osteoporosis
AU - Iacopo, Chiodini
AU - Alberto, Falchetti
AU - Daniela, Merlotti
AU - Cristina, Eller Vainicher
AU - Luigi, Gennari
PY - 2020/7/3
Y1 - 2020/7/3
N2 - 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.
AB - 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.
KW - Bisphosphonates
KW - Cushing disease
KW - denosumab
KW - fracture
KW - glucocorticoids
KW - osteoporosis
KW - subclinical hypercortisolism
KW - teriparatide
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U2 - 10.1080/17446651.2020.1772051
DO - 10.1080/17446651.2020.1772051
M3 - Review article
C2 - 32584619
AN - SCOPUS:85087530269
VL - 15
SP - 283
EP - 298
JO - Expert Review of Endocrinology and Metabolism
JF - Expert Review of Endocrinology and Metabolism
SN - 1744-6651
IS - 4
ER -