Clinical Rheumatology

, Volume 26, Issue 2, pp 144–153 | Cite as

Prevention and treatment strategies for glucocorticoid-induced osteoporotic fractures

  • Margaret GourlayEmail author
  • Nora Franceschini
  • Yevgeniy Sheyn


Glucocorticoids are the most common cause of drug-related osteoporosis. We reviewed current evidence on risk factors for glucocorticoid-induced osteoporosis (GIOP) and prevention and treatment of GIOP-related fractures. Guidelines for GIOP management published since 2000 were also reviewed. Significant bone loss and increased fracture risk is seen with daily prednisone doses as low as 5 mg. Alternate-day glucocorticoid therapy can lead to similar bone loss. No conclusive evidence exists for a safe minimum dose or duration of glucocorticoid exposure. Physicians should consider risk factors for involutional osteoporosis such as older age, postmenopausal status, and baseline bone density measurements as they assess patients for prevention or treatment of GIOP. Bisphosphonates were reported to reduce GIOP-related vertebral fractures, but inconclusive data exist for hip fractures associated with glucocorticoid use. Hormone replacement therapy and parathyroid hormone analogs are effective in preserving bone density in GIOP. The risk of osteoporosis and fractures should be routinely assessed in patients receiving glucocorticoid therapy. Effective prevention and treatment options are available and can result in meaningful reduction of GIOP-related morbidity and mortality. Current guidelines for GIOP management recommend bisphosphonates, especially alendronate and risedronate, as first-line agents for GIOP, and these guidelines propose the preventive use of bisphosphonates early in the course of glucocorticoid therapy in high-risk patient subgroups.


Fracture Glucocorticoid Osteoporosis Prevention Treatment 



Dr. Gourlay is supported by the University of North Carolina Program in Translational Science. Dr Franceschini is supported by the Center for Excellence in Pharmacoepidemiology in the UNC School of Public Health. Dr. Sheyn is supported by an NIH T32 Training grant.


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Copyright information

© Clinical Rheumatology 2006

Authors and Affiliations

  • Margaret Gourlay
    • 1
    Email author
  • Nora Franceschini
    • 2
  • Yevgeniy Sheyn
    • 3
  1. 1.Department of Family MedicineUniversity of North CarolinaChapel HillUSA
  2. 2.Department of Epidemiology, School of Public HealthUniversity of North CarolinaChapel HillUSA
  3. 3.Division of Rheumatology, School of MedicineUniversity of North CarolinaChapel HillUSA

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