Glucocorticoid-Induced Osteoporosis: Management Update

Osteoporosis due to glucocorticoid-induced osteoporosis (GIOP) for inflammatory disorders continues to be a common problem. Well-distributed guidelines have provided evidence-based recommendations for management, yet many patients have little attention paid to their increased fracture risk. The purpose of this article is to discuss how new treatments for GIOP may improve overall management. Intravenous zoledronic acid (ZA), an antiresorptive agent, and teriparatide (TPT), which stimulates osteoblasts, have received US Food and Drug Administration (FDA) approval for treating GIOP. ZA is appealing because one 15-min infusion covers the patient for a year and potentially will increase the proportion of GIOP patients who are treated. TPT makes physiologic sense because GIOP is mostly due to decreased osteoblast function, and TPT stimulates osteoblasts. Although there is only one small published study in humans with GIOP, denosumab is a potentially useful antiresorptive agent, if it is approved by the FDA. The efficacy and safety of these medications in GIOP are discussed.