Introduction: Glucocorticoids have major effects on bone metabolism, leading to accelerated osteoporosis and fracture.
Methods: This review will attempt to summarize current knowledge about their effects in light of new information and important remaining questions, especially with respect to management of this common clinical problem.
Results: Glucocorticoids affect bone through multiple pathways, influencing both bone formation and bone resorption. Evidence from randomised trials suggests that postmenopausal women receiving glucocorticoids are at greatest risk of rapid bone loss and consequent fracture and should be actively considered for prophylaxis. Based upon available evidence, the rank order of choice for prophylaxis would be a bisphosphonate followed by vitamin D. For established glucocorticoid induced osteoporosis, parathyroid hormone followed by a bisphosphonate appears useful.
Conclusions: Glucocorticoid-induced bone loss can be effectively prevented or reversed.