Glucocorticoids are a class of drugs that can reduce inflammation or immune system activity. However, as a side effect, they can weaken bones. This can result in glucocorticoid-induced osteoporosis.

Osteoporosis occurs when bones lose mass and bone mineral density (BMD) or when the bones become weaker. Ongoing or high dosage use of glucocorticoids can lead to weaker bones, which may cause glucocorticoid-induced osteoporosis.

Read on to learn more about how glucocorticoids can cause osteoporosis. This article also looks at symptoms, diagnosis, treatment options, and more.

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Glucocorticoids can lead to osteoporosis by interacting with cells called osteoblasts and osteoclasts.

Osteoblasts are the cells that lead to bone creation by converting proteins into new bone. Osteoclasts break down old bone to start the process of bone remodeling. This is the body’s way of strengthening bone and maintaining bone density.

According to a 2020 review, glucocorticoids may make osteoclasts mature more quickly, meaning the body reabsorbs more bone. The drug may also reduce the lifespan of bone-making osteoblasts and slow down the body’s production of osteoblasts.

Glucocorticoids also suppress hormones that support the growth and strengthening of bone. These include growth hormone and insulin-like growth factor 1 (IGF-1).

People can take glucocorticoids as a pill, injection, nasal spray, inhaler, or topical cream, depending on the condition requiring treatment. Oral or injectable corticosteroids carry the highest osteoporosis risk, according to the Endocrine Society.

Osteoporosis generally does not cause symptoms. People may not know they have it until they experience a fracture, usually from a fall.

The risk of fractures increases as early as 6 months into taking glucocorticoids. If a person has concerns about the risk of glucocorticoid-induced osteoporosis, it is best to contact a doctor for advice. It is important to continue to take any medication that a doctor has prescribed until they advise otherwise.

A low BMD is a clinical sign of osteoporosis. If a doctor suspects osteoporosis in an individual taking glucocorticoids, they may refer them for a test called dual-energy X-ray absorptiometry (DXA). This test helps doctors predict a person’s fracture risk.

However, people taking glucocorticoids may have an increased fracture risk even if they have a higher bone density than a doctor would expect. A doctor might also request X-rays or MRI scans to check the spine for fractures.

Learn more about screening tests for osteoporosis.

Treating glucocorticoid-induced osteoporosis might involve taking supplements to improve bone strength while also making lifestyle changes.

Doctors may also prescribe medication to some people with a high risk of osteoporosis if they are taking glucocorticoids.


People taking glucocorticoids for any length of time may benefit from supplementing calcium and vitamin D if they do not get enough daily.

The daily recommended amount of supplemental calcium is 1,000 milligrams (mg) to 1,200 mg, and people should aim to get 800 international units (IU) to 1,000 IU of vitamin D.

A doctor can check current blood levels through a blood test and advise on the exact dosage needed to maintain bone strength.

Learn about calcium for osteoporosis.

Lifestyle changes

People who need to take a long-term course of glucocorticoids may be able to reduce the risk of osteoporosis by:

  • practicing exercises that involve carrying body weight, such as running, dancing, or walking
  • engaging in exercises that promote better balance, such as yoga, which may help reduce the risk of falls
  • quitting or avoiding smoking
  • drinking no more than two alcoholic drinks per day


People with a high risk of osteoporosis might need to take medications to reduce their fracture risk. These include:

  • Bisphosphonates: These slow the breakdown of bone. Learn more about bisphosphonates for osteoporosis.
  • Abaloparatide and teriparatide: These support the production of new bone, strengthening bones and reducing fracture risk.
  • Denosumab: This increases bone mass and reduces the speed of bone breakdown.
  • Romosozumab: This creates new bone tissue and reduces how much bone loss occurs.

Learn about medications for osteoporosis.

Certain people have a higher risk of glucocorticoid-induced osteoporosis than others.

Doctors often prescribe medications along with glucocorticoids after menopause for people assigned female at birth. They may also recommend them for people assigned male at birth who are age 50 years or older.

People who take glucocorticoids and have previously had a fracture from a low impact injury may also need bone-protective medications.

The following are additional risk factors for osteoporosis:

  • using tobacco
  • having a vitamin D or calcium deficiency
  • drinking at least three alcoholic beverages per day
  • having a parent or sibling with osteoporosis

Learn more about the risk factors for osteoporosis.

Low impact fractures are the main complications of glucocorticoid-induced osteoporosis.

According to the American College of Rheumatology, these can cause:

  • long term pain
  • disability
  • death

Contacting a doctor as soon as a person has concerns about osteoporosis or factures can help reduce the likelihood of complications.

A person can reduce their risk of glucocorticoid-induced osteoporosis by starting preventive measures in the first few months of taking glucocorticosteroids. This is when bone loss is most rapid.

Taking calcium and vitamin D supplements, as well as the medications that treat active glucocorticoid-induced osteoporosis, may help prevent the bone weakness that causes easy fractures.

Here are some frequently asked questions about glucocorticoid-induced osteoporosis.

What medications are glucocorticoids?

Glucocorticoids are steroid hormone medications that reduce inflammation. Examples include betamethasone, dexamethasone, methylprednisolone, prednisolone, and triamcinolone.

What is the first-line treatment for glucocorticoid-induced osteoporosis?

According to a 2018 review, bisphosphonates are the first-line medication for the treatment of glucocorticoid-induced osteoporosis. This is because they generally have a lower cost. However, teriparatide may be more effective for some people.

What drugs are approved for glucocorticoid-induced osteoporosis?

The medications that currently have Food and Drug Administration (FDA) approval for glucocorticoid-induced osteoporosis treatment include alendronate, denosumab, risedronate, teriparatide, zoledronate, and romosozumab.

Glucocorticoid-induced osteoporosis can occur when glucocorticoids affect the cells that make or break down bone. This weakens the bones and increases a person’s risk of fractures.

Individuals at an increased risk of glucocorticoid-induced osteoporosis include males over the age of 50 years and females after menopause.

Some people may need to take medications such as bisphosphonates along with glucocorticoids to improve bone strength. Supplementing vitamin D and calcium from the start of a glucocorticoid course may also protect those who are deficient in these nutrients from osteoporosis.