Glucocorticoid-induced osteoporosis: pathogenesis, diagnosis, and management

Glucocorticoid-induced bone loss is dose- and duration-related, develops rapidly (within months of therapy), and leads to an increased risk of fractures. Moreover, less than one in four patients prescribed oral glucocorticoids receive any treatment to prevent or treat osteoporosis. The American College of Rheumatology recommends bisphosphonate therapy to prevent bone loss in most patients beginning long-term glucocorticoid therapy (prednisone equivalent of ≥5 mg/day for at least 3 months), and in men and postmenopausal women receiving long-term glucocorticoids who have an abnormal bone mineral density (T score below −1). Patients with glucocorticoid-induced osteoporosis are at particularly high risk for fractures, and should be treated aggressively to reduce fracture risk. Risedronate is approved in the United States for both prevention and treatment of glucocorticoid-induced osteoporosis and alendronate is approved for treatment. Both drugs increase bone mass in patients with established glucocorticoid-induced osteoporosis. Risedronate has been shown to significantly reduce the incidence of fractures after 1 year of treatment. Prevention or treatment of glucocorticoid-induced bone loss is recommended for patients at risk.