Glucocorticoid-Induced Osteoporosis

Treatment with glucocorticoids for inflammatory arthritis or other health problems may weaken bones. This can lead to osteoporosis. Treatment to protect bones can help prevent glucocorticoid-induced osteoporosis. Glucocorticoids are also called corticosteroids or steroids such as prednisone. Glucocorticoids may be used to treat autoimmune conditions. Glucocorticoids may have several negative effects to bone health. Risk factors include older age, smoking cigarettes, heavy alcohol use, small bone structure, Asian or non-Hispanic white background, family history of osteoporosis or prior fracture due to low level injury after age 50.

What Are the Signs/Symptoms?

Weakened bones and increased fracture risk are the main signs of glucocorticoid-induced osteoporosis. Patients taking glucocorticoids have a rapid loss of bone, even within the first six months of steroid treatment, and have a much higher rate of bone fractures. Osteoporotic fractures may lead to chronic pain, long-term disability and even death. Osteoporosis can be detected by bone mineral density (BMD); dual-energy X-ray absorptiometry (DXA) is a quick, painless test to measure BMD. Pregnant women should not have DXA, as it could harm the fetus. People taking glucocorticoids have an increased fracture risk at higher bone density levels than would be expected.

What Are Common Treatments?

Treatment of glucocorticoid-induced osteoporosis includes getting enough calcium and vitamin D. Patients should take at least 1,200 mg of calcium and 800-1,000 international units (IU) of vitamin D daily through supplements. There are several prescription medications approved to prevent or treat glucocorticoid-induced osteoporosis. Patients should work with their providers to take the lowest dose of glucocorticoids necessary for any condition, and consider medications as recommended.

Living with Glucocorticoid-Induced Osteoporosis

People taking glucocorticoids of more than 2.5 mg per day for three months are at higher risk for developing osteoporosis. Steps to help prevent osteoporosis include weight-bearing physical activity (such as walking on most days), quitting smoking, preventing falls, and early testing to diagnose osteopenia or osteoporosis. A patient’s main goal for management is to prevent fractures.

Updated February 2023 by Lisa Carnago, FNP, and reviewed by the American College of Rheumatology Committee on Communications and Marketing.

This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.