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How can long-term corticosteroid medication affect bone formation?

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bone disease Defect of tibia, caused by septic osteomyelitis in childhood, with compensatory thickening of the fibula (right). Normal bones are shown at left.

Long-term use of corticosteroid medication can significantly impair bone formation and lead to a decrease in overall bone mass.1

High concentrations of cortisol—the primary glucocorticoid in humans—suppress the synthesis of protein and mucopolysaccharides, which are essential for the development of the bone matrix. Furthermore, these hormones inhibit the incorporation of nucleosides into bone cells, directly hindering the formation process.1

Beyond these direct effects on bone cells, corticosteroids also impair the body's ability to absorb calcium through the intestines. This reduction in calcium absorption triggers an increase in the production of parathyroid hormone, which subsequently accelerates the rate of bone resorption (the breakdown of bone tissue).1

When these processes occur over an extended period, they can result in osteoporosis and a significantly increased risk of fractures, as seen in conditions like Cushing syndrome where corticosteroid levels are chronically elevated.12