Glucocorticoids are a type of steroid hormones that play a critical role in the metabolization of primarily carbohydrates and in immune system response. They are present in most vertebrates and are produced by their adrenal cortex. The most important natural glucocorticoid manufactured by our body is cortisol (1)
In medicine, synthetic glucocorticoids are used to treatt a variety of conditions such as autoimmune diseases, asthma, allergies, rheumatic disorders and cancer. They are also used as replacement therapy in cases of glucocorticoids deficiency or to suppress the immune system responses of the body. Some common glucocorticoids brands are Aristocort, Celestone, Cotolone, Decadron, Pms-Prednisolone, Prednicot and Prelone. (2)
Globally, approximately 5% of the total population of postmenopausal women take glucocorticoids as a part of their hormone replacement therapy. Though glucocorticoids are very beneficial they come with a slew of side effects such as such as edema of the face and body, palpitations, fatigue, mood swings, vein fragility etc. One of the most dangerous side effects is bone loss. It has been observed that postmenopausal women on hormone therapy lose bone mass rapidly in as early as the first 3-6 months of the hormone therapy. This puts them at an increased risk of developing osteoporosis and of falls and fractures. (3)
In March 2012, the International Osteoporosis Foundation, along with the European Society for Calcified Tissue released new guidelines of the prescription and usage of glucocorticoids with special reference to postmenopausal women. According to Dr. Tobie de Villiers, President of the International Menopause Society (IMS), “The ovaries stop producing estrogen around the time of the menopause, meaning that women find that the risk of bone loss and osteoporosis increases. This is already difficult for many women to cope with, so we need to be especially careful that the medicines which women take for other conditions don’t actually harm women’s bones. Glucocorticoids are important and valuable medicines, but like all medicines they have side effects and their use must be customised and monitored. Women, especially women after their menopause, need to be more aware of the possibility of this serious side-effect. These guidelines are aimed at allowing national organisations to develop effective systems to use glucocorticoids effectively.” (4)
Glucocorticoids or corticosteroids have direct as well as indirect bearing on the health of bone tissue. Glucocorticoids directly cause the reduction in the manufacture of bone cells osteoblasts thus reducing the rate of bone formation in the body. At another more indirect way, glucocorticoids also alter the body’s processing and channelling of calcium leading to further increase in the rate of bone loss. (5)
Any postmenopausal woman who has been on the hormone replacement therapy for more than 3 months should ask for a bone mineral density test like the Dual energy X-ray absorptiometry(DEXA) to be run to find out her bone health status especially around the hip and spine etc.
It has also been advised that such women who are on glucocorticoids medications for more than 3 months should check their calcium intake. If they are not getting enough through the dietary route, it is recommended they take supplements so that their daily intake of calcium is at least at 1200 mg. Similarly, their Vitamin D intake levels also need to be monitored so as to ensure they are getting between 400 to 1000 IU of vitamin D everyday through either food or supplements. Apart from this they should be physically active participating in daily walks and moderate weight-bearing exercises which would also go a long way to keeping their weight in check.
- Definition of Glucocorticoid; MedicineNet.com; April 2012; http://www.medterms.com/script/main/art.asp?articlekey=3609
- Corticosteroid (Oral Route, Parenteral Route); Mayo Clinic; April 2012; http://www.mayoclinic.com/health/drug-information/DR602333
- Menopause Clinicians Support New Advice On Steroid Use; Science Daily News; April 2012; http://www.sciencedaily.com/releases/2012/03/120330081737.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fhealth_medicine%2Fosteoporosis+
- Menopause clinicians support new advice on steroid use; International Menopause Society; April 2012; http://www.imsociety.org/pdf_files/comments_and_press_statements/ims_press_statement_30_03_12.pdf
- Glucocorticoid-Induced Osteoporosis; American College of Rheumatology – Practice Management; April 2012; http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/gi-osteoporosis.asp
- A framework for the development of guidelines for the management of glucocorticoid-induced osteoporosis; SpringerLink; April 2012; http://www.springerlink.com/content/w8l5p62h18602122/