What is the effect of systemic glucocorticoid therapy on bone mineral density?
The rate of glucocorticoid-induced bone density loss has been measured at 10-30% per year as compared to natural menopause, with a rate of loss measured at 1-2% per year.
Glucocorticoids decrease bone density via several mechanisms
- Stimulation of osteoclasts thereby increasing bone resorption
- Suppression of osteoblastic activity resulting in decreased bone formation
- Decreased sex hormone production
- Reduced calcium absorption by the intestine and kidney
The rate of bone density loss is highest in the first six months when all of the above mechanisms are active. After six months of use, osteoclast stimulation decreases. Subsequently, bone density loss continues at slower but steady rate due primarily to decreased bone formation (1-3).
- Canalis E, Mazziotti G, Giustina A, Bilezikian JP. Glucocorticoid-induced osteoporosis: pathophysiology and therapy.. Osteoporos Int 2007; 18: 1319.
- Canalis E, Bilezikian JP, Angeli A et al. Perspectives on glucocorticoid-induced osteoporosis. Bone 2004; 34: 593-598.
- Sambrook P, Birmingham J, Kempler S, et al. Corticosteroid Effects on Proximal Femur Bone Loss. J Bone Min Res 1990; 5: 1211-1216.