Glucocorticoid-induced Osteoporosis

Glucocorticoid-induced osteoporosis or “GIOP” for short is the leading cause of secondary osteoporosis – meaning something produces the disease osteoporosis. That is “glucocorticoids,” which are steroids. Natural glucocorticoids are hormones made in the outside portion of the adrenal gland that sits on top of your kidneys. Cortisol is the major natural glucocorticoid. Medicines classified as glucocorticoid are equivalent hormones that are given for treatment of a variety of diseases or problems.


The most common glucocorticoid prescribed is prednisone. Bone loss appears to be dose-related. Higher doses are correlate with greater the risk of bone loss and fracture. Although any dose may promote bone loss, guidelines for protective therapy start with doses of 5 to 7.5 milligram or more depending on your age and for women, child-bearing status.

Accelerates Bone Loss

Regular use of steroids accelerates bone loss and puts you at risk for fractures at a higher bone mineral density level than postmenopausal osteoporosis. In contrast to bone loss with menopause, steroids affect the bone building cells more than bone breakdown cells causing a marked decrease in bone formation.

Prevention and Treatment

Steroids also have a direct effect on muscle that increases your risk of falls. Fall prevention along with the basic bone health measures of lifestyle, calcium, and vitamin D are part of overall prevention and treatment. The FDA-approved medicines for individuals on steroids include Actonel, Forteo, Fosamax and generic alendronate, and Reclast. Recommendations published by the American College of Rheumatology in 2010 are helpful starting point for anyone who is starting or taking steroid therapy to discuss with their doctor.

Other Resources:

American College of Rheumatology 2010 Recommendations for Prevention and Treatment of Glucocorticoid-induced Osteoporosis