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Glucocorticoid-Induced Osteoporosis: Update on Management

  • Osteoporosis (A Lau, Section Editor)
  • Published:
Current Treatment Options in Rheumatology Aims and scope Submit manuscript

Abstract

Purpose of review

Glucocorticoids (GCs) are potent anti-inflammatory and immunosuppressant drugs that are used to treat many inflammatory conditions across different fields of medicine. Glucocorticoid-induced osteoporosis (GIOP) is a significant comorbidity associated with long-term steroid use (> 3 months). The purpose of this review is to provide an update in the management of glucocorticoid-induced osteoporosis.

Recent findings

New data for use of denosumab in GIOP includes a large clinical trial showing greater gains in bone density and no differences in adverse effects compared to risedronate. Another study suggests a reduction in hip fractures with alendronate. Meta-analyses and systematic reviews demonstrate an increase in bone mineral density as well as reduction in vertebral fractures with bisphosphonates in GIOP. Recent guidelines from the American college of Rheumatology provide concise suggestions for screening, prevention, and treatment of patients with GIOP. Adequate clinical fracture risk assessment should be obtained for each patient who is expected to receive glucocorticoids for long term. All patients should receive calcium, vitamin D supplementation, and lifestyle counselling. Pharmacologic treatment should be offered to patients who have a moderate to high risk of fractures. Oral followed by IV bisphosphonate remain the first line of treatment. The guidelines recommend other agents including teriparatide and denosumab to be considered as second- and third-line agents, respectively.

Summary

Glucocorticoid-induced osteoporosis caused by long-term steroid use is associated with significant comorbidity and is often under-treated by clinicians. New clinical trials, meta-analyses, and guidelines offer new strategies for assessment and management.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Acknowledgements

We thank Joshua Melnick who helped in creating the figure.

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Authors and Affiliations

  1. Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham Alabama, Faculty Office Tower (FOT) Room 820D, 510 20th Street South, Birmingham, AL, 35294-3408, USA

    Aprajita Jagpal MD & Kenneth G. Saag MD

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  1. Aprajita Jagpal MD
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  2. Kenneth G. Saag MD
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Correspondence to Kenneth G. Saag MD.

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Aprajita Jagpal declares that she has no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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This article is part of the Topical Collection on Osteoporosis

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Jagpal, A., Saag, K.G. Glucocorticoid-Induced Osteoporosis: Update on Management. Curr Treat Options in Rheum 4, 279–287 (2018). https://doi.org/10.1007/s40674-018-0105-3

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  • DOI: https://doi.org/10.1007/s40674-018-0105-3

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