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Highly Accessed Review

Cortical remodeling during menopause, rheumatoid arthritis, glucocorticoid and bisphosphonate therapy

Daniel Aeberli1* and Georg Schett2

Author affiliations

1 Department of Rheumatology and Clinical Immunology/Allergology, Inselspital Bern, University of Bern, CH-3012 Bern, Switzerland

2 Department of Internal Medicine 3, University Clinic of Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany

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Citation and License

Arthritis Research & Therapy 2013, 15:208  doi:10.1186/ar4180

Published: 21 March 2013

Abstract

Bone mass, bone geometry and its changes are based on trabecular and cortical bone remodeling. Whereas the effects of estrogen loss, rheumatoid arthritis (RA), glucocorticoid (GC) and bisphosphonate (BP) on trabecular bone remodeling have been well described, the effects of these conditions on the cortical bone geometry are less known. The present review will report current knowledge on the effects of RA, GC and BP on cortical bone geometry and its clinical relevance. Estrogen deficiency, RA and systemic GC lead to enhanced endosteal bone resorption. While in estrogen deficiency and under GC therapy endosteal resorption is insufficiently compensated by periosteal apposition, RA is associated with some periosteal bone apposition resulting in a maintained load-bearing capacity and stiffness. In contrast, BP treatment leads to filling of endosteal bone cavities at the epiphysis; however, periosteal apposition at the bone shaft seems to be suppressed. In summary, estrogen loss, RA and GC show similar effects on endosteal bone remodeling with an increase in bone resorption, whereas their effect on periosteal bone remodeling may differ. Despite over 50 years of GC therapy and over 25 years of PB therapy, there is still need for better understanding of the skeletal effects of these drugs as well as of inflammatory disease such as RA on cortical bone remodeling.