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Glucocorticoid-related bone changes from endogenous or exogenous glucocorticoids.
[cushing syndrome]
Glucocorticoids
have
a
negative
impact
on
bone
through
direct
effects
on
bone
cells
and
indirect
effects
on
calcium
absorption
.
Here
,
recent
findings
regarding
glucocorticoid-induced
osteoporosis
,
bone
changes
in
patients
with
endogenous
glucocorticoid
derangements
,
and
treatment
of
steroid-induced
bone
disease
are
reviewed
.
Although
the
majority
of
our
understanding
arises
from
the
outcomes
of
patients
treated
with
exogenous
steroids
,
endogenous
overproduction
appears
to
be
similarly
destructive
to
bone
,
but
these
effects
are
reversible
with
cure
of
the
underlying
disease
process
.
Additionally
,
there
are
bone
changes
that
occur
in
diseases
that
interrupt
adrenal
glucocorticoid
production
,
both
in
response
to
our
inability
to
perfectly
match
glucocorticoid
replacement
and
also
related
to
the
underlying
disease
process
.
More
investigation
is
required
to
understand
which
patients
with
endogenous
overproduction
or
underproduction
of
glucocorticoid
would
benefit
from
osteoporosis
treatment
.
Better
understood
is
the
benefit
that
can
be
achieved
with
currently
approved
treatments
for
glucocorticoid-induced
osteoporosis
from
exogenous
steroids
.
With
growing
concern
of
long
-term
use
of
bisphosphonates
,
however
,
further
investigation
into
the
duration
of
use
and
use
in
certain
populations
,
such
as
children
and
premenopausal
women
,
is
essential
.
Glucocorticoid-induced
osteoporosis
is
a
complex
disease
that
is
becoming
better
understood
through
advances
in
the
study
of
exogenous
and
endogenous
glucocorticoid
exposure
.
Further
advancement
of
proper
treatment
and
prevention
is
on
the
horizon
.
Diseases
Validation
Diseases presenting
"further advancement"
symptom
cushing syndrome
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