Introduction
Glucocorticoids are commonly used for their anti-inflammatory and immunomodulatory properties in the treatment of a wide range of inflammatory, immunological, allergic and malignant diseases. A recent population study from Denmark found that the annual prevalence of systemic (oral and injectable) glucocorticoid use was ~3%, increasing to 6.7-7.7% in people 60-79 years of age and to 9.7-11% in those ≥80 years of age [1]. In 2018 in England, 8 million prescriptions for systemic glucocorticoids, 21 million prescriptions for inhaled glucocorticoids and 12 million prescriptions for topical glucocorticoids were dispensed in the community [2]. Glucocorticoids bind to glucocorticoid receptors, which are expressed in almost every cell in the body and have pleiotropic effects on multiple signalling pathways [3]. This makes them highly effective anti-inflammatory drugs, but also causes diverse serious adverse effects that limit their use.