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Glucocorticoids, Inflammation and Bone

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Abstract

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.

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Authors and Affiliations

  1. Department of Rheumatology and Clinical Immunology, Maasstad hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands

    Melek Güler-Yüksel

  2. Bravis hospital, Boerhaaveplein 1, 4624 VT, Bergen op Zoom and Boerhaavelaan 25, 4708 AE, Roosendaal, The Netherlands

    Jos N. Hoes

  3. Department of Rheumatology, Amsterdam Rheumatology and immunology Center, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands

    Irene E.M. Bultink & Willem F. Lems

Authors
  1. Melek Güler-Yüksel
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  2. Jos N. Hoes
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  3. Irene E.M. Bultink
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  4. Willem F. Lems
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Correspondence to Melek Güler-Yüksel.

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Conflict of interest

MGY received consultant and/or speaker fees from Eli Lilly and Company Netherlands and Abbvie. IEMB received consultant and/or speaker fees from Eli Lilly and Company Netherlands, Merck Sharpe and Dohme, Amgen, UCB Pharma, Roche Netherlands and Sanofi Genzyme. WFL received consultant and/or speaker fees from Amgen, Merck Sharpe, Eli Lilly, Pfizer, Roche, Abbvie and Sanofi Genzyme. JNH declares no conflict of interest.

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Güler-Yüksel, M., Hoes, J.N., Bultink, I.E. et al. Glucocorticoids, Inflammation and Bone. Calcif Tissue Int 102, 592–606 (2018). https://doi.org/10.1007/s00223-017-0335-7

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  • DOI: https://doi.org/10.1007/s00223-017-0335-7

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