Glucocorticoid-induced osteoporosis and osteonecrosis

Abstract

Glucocorticoid administration is the most common cause of secondary osteoporosis and the leading cause of nontraumatic osteonecrosis. In patients receiving long-term therapy, glucocorticoids induce fractures in 30% to 50% and osteonecrosis in 9% to 40%. This article reviews glucocorticoid-induced osteoporosis and osteonecrosis, addressing the risk factors, pathogenesis, evaluation, treatment, and uncertainties in the clinical management of these disorders.

Figure 1

Glucocorticoid Excess Causes Osteoporosis and Osteonecrosis by Direct Effects on Bone Cells.

Figure 2

Osteocyte Apoptosis in Glucocorticoid-Induced Osteonecrosis of the Hip. Femoral head specimen taken from a patient with glucocorticoid-induced osteonecrosis during hip replacement. Apoptotic osteocytes (arrows) and lining cells (arrowheads) are stained brown by in situ end labeling (x200).