Table 2.

Treatment of Glucocorticoid-Induced Osteoporosis.

Intervention	Advantages	Disadvantages
Alendronate (oral; 10 mg/d or 70 mg/wk), risedronate (5 mg/d or 35 mg/wk)	Osteoclast inhibition reduces    bone loss. Alendronate also    prevents glucocorticoid-    induced osteocyte apoptosis.    If glucocorticoids are    discontinued, these drugs can    be stopped.	Antiresorptive agents do not directly    address the decreased bone    formation characteristic of    glucocorticoid-induced bone    disease. Additional problems    include gastrointestinal side    effects, rare uveitis, poor    compliance with oral therapy, and    the time required to obtain skeletal    protection. Avoid in patients with    a creatinine clearance less than 30    mL/min.
Zoledronic acid (5 mg IV/yr)	Osteoclast inhibition reduces    bone loss. Increased    compliance compared with    oral treatment and rapid onset    of skeletal effects.    Gastrointestinal side effects    are unlikely.	Does not address the reduced bone    formation caused by glucocorticoid    excess. Avoid in patients with a    creatinine clearance less than 30    mL/min.
Teriparatide (20 µg subcut/d)	Directly addresses the    pathogenesis of GIO.    Reduces vertebral fractures.	Cost, daily injections are required,    reduced response with high dose    glucocorticoids. Not studied in    patients with elevated parathyroid    hormone levels. Adverse effects:    mild hypercalcemia, headache,    nausea, leg cramps, dizziness.    Caution with pre-existing    nephrolithiasis. Check serum    calcium at least once ≥16 hours    after injection and adjust oral    calcium intake as needed (54).
Denosumab (60 mg subcut every 6 mo)	Potent inhibitor of osteoclasts    with ease of administration.    Can be stopped if    glucocorticoids are    discontinued. Useful in renal    insufficiency.	Does not address the reduced bone    formation caused by glucocorticoid    excess. Not yet approved for GIO.
Vertebroplasty, kyphoplasty	Commonly used to treat recent    painful vertebral fractures.	Beneficial effects similar to sham    procedures. Dangers of cement    leakage. Increased incidence of    additional fractures in patients    receiving glucocorticoids (58).