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Glucocorticoid-induced osteoporosis update

Adami, Giovannia,b; Saag, Kenneth G.a

Current Opinion in Rheumatology: July 2019 - Volume 31 - Issue 4 - p 388–393
doi: 10.1097/BOR.0000000000000608
METABOLIC BONE DISEASE: Edited by Stephen Honig

Purpose of review Steroid-induced osteoporosis or glucocorticoid-induced osteoporosis (GIOP) is a common form of secondary osteoporosis and is a cause of increased morbidity and mortality. The pathogenesis of GIOP includes decreased bone formation and increased bone resorption. Clinicians can rely on several effective medications for the treatment and prevention of GIOP, including antiresorptive drugs (i.e. bisphosphonates) and bone anabolic drugs (i.e. teriparatide).

Recent findings Recent studies have further highlighted that GIOP is a major public health concern and have provided new insights on the pathogenesis of GIOP, in particular, the dose-dependent effects of glucocorticoids on bone. New evidence on the real-world effectiveness of established GIOP therapies have been recently published as well as the results of the 24-months denosumab randomized controlled trial in GIOP.

Summary GIOP and fragility fractures are important adverse events related to the long-term use of glucocorticoids. Recent studies have provided additional data on the epidemiology and pathogenesis of GIOP and on the efficacy and effectiveness of GIOP therapies.

aDivision of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA

bRheumatology Unit, University of Verona, Verona, Italy

Correspondence to Kenneth G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 510 20th Street South, Faculty Office Tower 820D, Birmingham, AL 35294, USA. Tel: +1 205 996 9784; e-mail:

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