Advances in treatment of glucocorticoid-induced osteoporosis

Curr Opin Endocrinol Diabetes Obes. 2017 Dec;24(6):411-417. doi: 10.1097/MED.0000000000000368.


Purpose of review: The aim of this study is to summarize monitoring, prevention and treatment options of glucocorticoid-induced osteoporosis for patients on chronic glucocorticoid therapy.

Recent findings: Recent meta-analyses highlight the efficacy of bisphosphonate use in improving bone mineral density and in reducing vertebral fractures in the setting of long-term glucocorticoid use. A new study has now shown that alendronate also reduces the risk of hip fracture in glucocorticoid use. Emerging data indicate that teriparatide and denosumab also reduce the risk of osteoporotic fracture in glucocorticoid-induced osteoporosis.

Summary: Glucocorticoid use is a leading cause of secondary osteoporosis; however, patients at risk of glucocorticoid-induced osteoporosis are often not evaluated or treated in a timely manner. Patients on a dose equivalent of 2.5 mg prednisone or greater for 3 months or longer duration should have their fracture risk assessed. Those at moderate or high risk should start bisphosphonate therapy, or if contraindicated, a second-line agent such as teriparatide or denosumab.

Publication types

  • Review

MeSH terms

  • Alendronate / therapeutic use
  • Bone Density / drug effects
  • Bone Density Conservation Agents / therapeutic use*
  • Denosumab / therapeutic use
  • Diphosphonates / therapeutic use
  • Glucocorticoids / adverse effects*
  • Humans
  • Monitoring, Physiologic / methods
  • Monitoring, Physiologic / trends
  • Osteoporosis / chemically induced*
  • Osteoporosis / drug therapy*
  • Osteoporosis / prevention & control
  • Osteoporotic Fractures / prevention & control*
  • Preventive Medicine / methods
  • Preventive Medicine / trends
  • Spinal Fractures / chemically induced
  • Spinal Fractures / drug therapy
  • Teriparatide / adverse effects


  • Bone Density Conservation Agents
  • Diphosphonates
  • Glucocorticoids
  • Teriparatide
  • Denosumab
  • Alendronate