Mechanisms

Osteoporosis is a systemic skeletal disorder characterized by reduced bone mass and microarchitectural deterioration, leading to increased fracture risk. Multiple factors contribute to its pathogenesis, including hormonal deficiencies (estrogen, testosterone, and growth hormone), metabolic imbalances, chronic inflammation, glucocorticoid therapy, and lifestyle-related influences. Glucocorticoids (GCs) play a significant role in osteoporosis by inhibiting osteoblast differentiation, promoting osteoclast activity via the RANKL-OPG pathway, impairing calcium absorption, and disrupting vitamin D metabolism. Additionally, inflammatory cytokines, growth factors, and prostanoids influence bone remodeling, further exacerbating bone loss. Management strategies include lifestyle modifications, adequate calcium and vitamin D intake, pharmacologic interventions (bisphosphonates, SERMs, PTH analogs, and monoclonal antibodies), and hormone replacement therapy where applicable. Early detection and intervention are essential to prevent fractures and maintain skeletal health.