Prevention and Treatment of Glucocorticoid‐Induced Osteoporosis

Publication Date: October 16, 2023
Last Updated: December 19, 2023

Key Recommendations

  1. As soon as possible after initiation of ≥2.5 mg/day GC treatment for >3 months, screening for fracture risk in patients ≥40 years of age should be assessed by using FRAX® and by performing bone mineral density (BMD) using dual-energy x-ray absorptiometry (DXA) with vertebral fracture assessment (VFA) testing or spinal x-rays. BMD with VFA testing or spinal x-ray is advised in patients <40 years, as FRAX® is not validated in this population.
  2. Adequate age-appropriate dietary and supplemental intake of calcium and vitamin D, weight-bearing exercise, and avoidance of smoking and excessive alcohol intake is encouraged for all patients receiving GCs.
  3. All adult patients >18 years of age with medium, high, or very high fracture risk should be offered osteoporosis (OP) therapy.
  4. Oral bisphosphonates (BP) are strongly recommended over no treatment in high or very high fracture risk adults.
  5. For adults >18 years of age with very high fracture risk, anabolic agents (parathyroid hormone [PTH] and PTH-related protein [PTHrP]) are conditionally recommended over antiresorptive agents (BP or denosumab [DEN]).
  6. In adults ≥40 years of age at high risk of fracture, DEN or PTH or PTH or PTH or PTH/ PTHrP are conditionally recommended over BP.
  7. In adults >18 years of age at moderate risk of fracture, oral or intravenous (IV) BP, DEN, and PTH and PTH and PTH and PTH/PTHrP are conditionally recommended.
  8. Include in decision-making that sequential OP treatment is recommended to prevent rebound bone loss and vertebral fractures after discontinuation of DEN, romosozumab, and PTH and PTH and PTH and PTH/PTHrP.


Table 3. Recommendations for Initial Treatment for Prevention of GIOP in Adults Beginning Long-term GC Therapy

Recommendations for patients taking prednisone ≥2.5 mg/day for >3 months

For adults and children beginning or continuing chronic GC treatment at low, moderate, high, or very high risk of fracture, we conditionally recommend optimizing dietary and supplemental calcium and vitamin D in addition to lifestyle modifications. (Low-quality evidence, Conditional recommendation)



Prevention and Treatment of Glucocorticoid‐Induced Osteoporosis

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