[Glucocorticoid-induced osteoporosis. A underestimated sequela of long-term treatment of autoimmune diseases].

The treatment of autoimmune diseases with systemic glucocorticosteroids remains a therapeutic challenge and requires close collaboration with internists, radiologists and in some cases orthopedic surgeons. Generally, patients initially receive high-dose glucocorticosteroid therapy and are then treated for a longer period of time with moderate to low doses above the level causing symptoms of Cushing's disease. A major cause of complications is glucocorticosteroid-induced osteoporosis with hip fractures, crush fractures of the spine and other low trauma fractures as well as deformities of the skeleton leading to neurological and other systemic problems. Loss of bone mass as a result of high dose or long term systemic glucocorticosteroid treatment is well studied and can be documented in a standardized and reproducible fashion using modern radiological techniques. In recent years several controlled studies of bone loss and therapy of osteoporosis have been published, mostly including patients with rheumatoid arthritis or systemic lupus erythematosus. This review discusses recent publications and provides a brief overview on therapeutic options.