How do Glucocorticoids cause osteoporosis?
GCs adversely affect both phases of bone remodeling leading to rapid loss of bone. They impair bone formation by promoting apoptosis of existing osteoblasts and reducing the development of new osteoblasts. They increase bone resorption by decreasing the production of sex steroids and osteoprotegerin, an endogenous inhibitor of bone resorption. Osteocytes are also affected and undergo apoptosis.
Pearl: Patients on GCs fracture at higher/better BMD values (T-scores) than patients with other types of osteoporosis.