Current Treatment for Glucocorticoid-Induced Osteoporosis: Beyond Bisphosphonates

Glucocorticoid-induced osteoporosis (GIOP) is a leading cause of secondary osteoporosis, and vertebral and hip fractures are increased with glucocorticoid (GC) doses higher than 2.5 mg daily. Despite the high prevalence of GC therapy, most patients receiving GC are not evaluated or treated for GIOP, leading to increases in preventable fractures.

Several treatments are available for the prevention or treatment of GIOP. Drug classes include antiresorptive therapies (bisphosphonates and denosumab), anabolic agents (teriparatide, abaloparatide, and romosozumab), and selective estrogen receptor modulators (raloxifene). Studies indicate that anabolic agents are preferred over antiresorptive therapies, but both classes improve bone mineral density (BMD) and prevent fractures.

Based on more significant reductions in vertebral fractures in GIOP, teriparatide is now preferred as initial therapy for patients who are at high or very high risk of fractures taking glucocorticoids for three or more months. Anabolic agents (teriparatide, abaloparatide, romosozumab) and denosumab require sequential therapy to prevent bone loss and vertebral fractures. Other emerging drugs, including romosozumab and abaloparatide, may also be helpful in GIOP.