How is glucocorticoid-induced osteoporosis managed differently from age-related osteoporosis?

• A. Prevention includes early calcium and vitamin D and considering antiresorptives or denosumab for high-risk patients on steroids; minimize glucocorticoid exposure; monitor bone density earlier.
• B. Prevention includes only calcium supplementation.
• C. Glucocorticoids do not affect bone.
• D. Wait until fracture occurs before treating.

Answer: (D)

Rapid bone loss from glucocorticoids means prevention and early intervention are essential, not waiting for a fracture to occur. Glucocorticoids accelerate osteoporosis by suppressing bone formation and increasing resorption, and they can reduce calcium absorption, with the most rapid loss occurring after starting therapy and with higher doses. Because of this, the management approach starts as soon as glucocorticoids are prescribed and continues throughout treatment.

Key steps include ensuring adequate calcium and vitamin D intake and correcting deficiency, plus lifestyle measures such as weight-bearing exercise and fall prevention. Strive to use the lowest effective glucocorticoid dose and taper when possible to minimize exposure. Baseline bone density testing and more frequent monitoring are used to track changes over time, since bone loss can occur quickly on steroids.

For those at higher risk or continuing glucocorticoid therapy, pharmacologic prevention is often warranted. Anti-resorptives like bisphosphonates or denosumab are commonly started to protect bone, and anabolic therapy such as teriparatide may be considered in certain cases. The emphasis is on preventing fractures through early, proactive treatment rather than waiting for a fracture to guide therapy.