Keywords
Glucocorticoids
Fractures
Bone
Bisphosphonates
Alendronate
Bone Density
How to Cite
Abstract
Introduction: Glucocorticoid-induced osteoporosis (GIOP) is a common secondary osteoporosis resulting from chronic corticosteroid use. It affects bone homeostasis, leading to significant reductions in bone mineral density (BMD) and an increased risk of vertebral and non-vertebral fractures. Due to the increasing number of patients requiring long-term glucocorticoid therapy, a comprehensive understanding of pharmacological interventions available for glucocorticoid-induced osteoporosis is essential.
Objective: To evaluate the efficacy, effectiveness, and safety of different pharmacological therapies used in the management of patients with glucocorticoid-induced osteoporosis through a scoping review of the available literature.
Methods: Following the Joanna Briggs Institute (JBI) methodology, a scoping review was conducted using major databases (PubMed, Embase, Cochrane, and others). Studies including adults with glucocorticoid-induced osteoporosis treated with pharmacological therapies such as bisphosphonates, denosumab, teriparatide, and others were considered. Outcomes focused on changes in bone mineral density, fracture risk reduction, and treatment safety. A total of 40 studies were included (37 on efficacy, 1 on effectiveness, and 12 on safety).
Results: Bisphosphonates (e.g., risedronate, alendronate, and zoledronate) significantly improved lumbar spine bone mineral density (up to +4.8%; with variability across studies, including mean changes around +4.9% ± 4.5% in randomized controlled trials [RCTs]) and reduced vertebral fracture risk (by up to 82.4%). Teriparatide demonstrated superior efficacy in increasing bone mineral density (+7.8% to +11.0%) and reducing fracture incidence, especially in high-risk patients. Denosumab also showed notable improvements in bone mineral density and bone turnover markers. Adverse events were generally mild, with gastrointestinal and flu-like symptoms being the most commonly reported.
Discussion: Bisphosphonates remain the first-line therapy for glucocorticoid-induced osteoporosis due to their efficacy and safety profile. Teriparatide may be preferable for high-risk patients or those with severe bone formation suppression. Denosumab is a valid alternative, particularly for patients who are intolerant to bisphosphonates. This review highlights the importance of individualized therapy based on fracture risk and comorbidities.
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