Do Glucocorticoids Weaken Bones? Discover Risk & Management of Glucocorticoid-Induced Osteoporosis

Glucocorticoids are widely used to suppress the immune system in certain medical conditions. So, people who are using glucocorticoids for prolonged periods of time can experience bone loss. This eventually leads to a condition called glucocorticoid-induced osteoporosis. This is seen as the common cause of secondary osteoporosis in people under glucocorticoids. This might cause fear among people who take glucocorticoids. However, there are some management strategies that can be done to overcome this. Basically, a combination of pharmacological and non-pharmacological management is recommended. This article will discuss the cause, risk factors, and treatment options for this condition.

What is glucocorticoid-induced osteoporosis (GIO)?

As mentioned earlier, glucocorticoid-induced osteoporosis (GIO) is predominantly seen in individuals who are prescribed glucocorticoid medications. As a side effect of this medication, they experience bone weakening, known as osteoporosis. Who is given glucocorticoids? People with autoimmune disorders, allergies, asthma, adrenal insufficiency, heart failure, cancer, skin conditions, and sometimes, as part of surgical treatment plans, are often treated with glucocorticoids.

What contributes to glucocorticoid-induced osteoporosis?

Glucocorticoids make the cells responsible for building bones work less effectively, directly and indirectly. They also seem to trigger the breaking down of bone tissue, which leads to bone loss when someone starts taking these medications.  The risk of breaking bones is related to how much and how long someone takes glucocorticoid medications. When they stop taking these medications, the risk of fractures goes down quickly. Also, the health condition that needs these medications can weaken bones.

How can we evaluate the fracture risk in patients under glucocorticoids?

For the evaluation of fracture risk, tools such as FRAX are recommended in all patients treated with glucocorticoids, preferably around the time of treatment initiation. The Fracture Risk Assessment Tool (FRAX), introduced by the World Health Organization in 2008, is a widely accepted tool used by doctors. It helps predict the chance of having a major bone fracture, like in the spine, forearm, hip, or shoulder, over the next 10 years. . FRAX uses information from various populations around the world and even takes into account different ethnic backgrounds.

What is the pharmacological management for Glucocorticoid-induced osteoporosis?

When someone is at a high risk of breaking bones because of osteoporosis, doctors often recommend using medications to help strengthen their bones. 

There are two main types of medications for this: 

1. Anti-resorptives

The most common option is anti-resorptives. These include medications like bisphosphonates, which work by slowing down the process of bone breakdown. Another option is estrogen therapy, which can help maintain bone density, especially in women going through menopause. Raloxifene is another medication that works similarly to estrogen therapy.

Another option is salmon calcitonin, which helps slow down bone breakdown and may also have some pain-relieving effects.

2. Anabolic therapy

On the other hand, anabolic therapy, like Tricium PTH PEN Injection. This injection contains the active ingredient teriparatide which works by stimulating the formation of new bone tissue. It’s a bit like giving your bones a boost to make them stronger.

So, depending on someone’s specific situation and risk factors, their doctor may recommend one of these medications to help keep their bones healthy and reduce the risk of fractures.

What is the Non-pharmacological management for GIO?

For people who are on long-term treatment with glucocorticoid medications, it’s really important to do more than just take pills. Non-pharmacological management means using methods other than medicine to help with the condition.

1. One big part of this is making sure to eat well and exercise regularly. Eating foods rich in calcium and taking vitamin D supplements can help keep bones strong.
2. Exercise is super important too. Activities like walking, dancing, or even lifting light weights can all help build bone strength and keep muscles strong. Strong muscles can also protect bones from injury.
3. Another important aspect is preventing falls. Simple things like making sure your home is free of tripping hazards, using handrails on stairs, and wearing sturdy shoes can make a big difference.

So, along with taking their medication, people on long-term glucocorticoid treatment should focus on eating right, staying active, and preventing falls to keep their bones as healthy as possible.

Conclusion

GIO poses a significant risk for fragile bones and fractures, yet many patients don’t receive appropriate treatment. Lifestyle changes and medications, such as oral bisphosphonates, are recommended to strengthen bones and prevent fractures. For those at higher risk or unable to take oral medications, alternative options like injections are available. Through proper care and treatment, we can better protect bone health and reduce the risk of fractures in people taking glucocorticoids.