Abstract
Glucocorticoid-induced osteoporosis (GIOP) continues to be the most common cause of secondary osteoporosis because at any time about 1% of the adult population has been prescribed oral glucocorticoids. Surprisingly, there are relatively few treatment studies of GIOP, particularly of younger individuals including women of child bearing potential and children. Thus, recommendations for management of patients at risk for fracture or who have already suffered an osteoporotic fracture are often based more on clinical experience than randomized controlled trials. Nonetheless, organizations such as the American College of Rheumatology have provided guidance on management of GIOP. In this review, the treatment of GIOP is discussed in light of the specific pathophysiology of this disorder. What separates GIOP from other types of osteoporosis is the profound decrease in osteoblastic function and fact that 3 months (or less) of glucocorticoid therapy leads to a demonstrable increase in fracture incidence. The new ACR Guideline uses FRAX and bone mineral density to categorize fracture risks in GIOP and advocates use of oral bisphosphonates for most patients. Other new findings and alternative management approaches are also discussed.
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Robert A. Adler, MD is the sole author of this manuscript.
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The manuscript was done as part of regular duties as an endocrinologist for the Department of Veterans Affairs. The opinions are those of the author and not necessarily those of the Department of Veterans Affairs.
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The manuscript is a review and thus does not contain primary data on any study in humans or animals performed by the author.
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Adler, R.A. Glucocorticoid-Induced Osteoporosis and the New ACR Guideline. Clinic Rev Bone Miner Metab 15, 123–127 (2017). https://doi.org/10.1007/s12018-017-9234-8
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DOI: https://doi.org/10.1007/s12018-017-9234-8