{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T14:34:29Z","timestamp":1787668469359,"version":"build-2736575974"},"reference-count":100,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Department of Endocrine Disorders and Bone Metabolism, Medical University of Lodz","award":["503\/1-153-07\/503-21-001-19-00"],"award-info":[{"award-number":["503\/1-153-07\/503-21-001-19-00"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Glucocorticoids (GCs) are widely used for their potent anti-inflammatory and immunosuppressive effects, but their use is strongly associated with negative impacts on bone health. Rapid bone loss and an increased risk of fragility fractures are characteristics of glucocorticoid-induced osteoporosis (GIOP), the most common type of secondary osteoporosis. While oral GCs are a well-known cause of GIOP, growing evidence suggests that non-oral routes of administration may also negatively affect the skeleton. This review summarizes current knowledge on the pathophysiology of GIOP, highlighting the complex relationship between direct and indirect mechanisms. It examines the effects of various routes of GC administration\u2014oral, intravenous, inhaled, topical, and epidural\u2014on bone mineral density, microarchitecture, and fracture. While parenteral GCs may have fewer systemic effects than oral therapy, long-term exposure or high cumulative doses may still cause clinically significant skeletal deterioration. This review also discusses current methods for assessing, preventing, and treating the fracture risk associated with GIOP. These strategies include lifestyle modifications, calcium and vitamin D supplements, and medications such as denosumab, bisphosphonates, and anabolic agents. Reducing the incidence of glucocorticoid-associated fractures and improving prevention and treatment requires an understanding of how GCs impact bone.<\/jats:p>","DOI":"10.3390\/jcm15072488","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T09:11:14Z","timestamp":1774429874000},"page":"2488","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Glucocorticoid-Induced Osteoporosis: Pathogenesis, the Impact of Different Administration Routes on Bone Mineral Density, and Fracture Risk and Treatment Options\u2014A Narrative Review"],"prefix":"10.3390","volume":"15","author":[{"given":"Monika","family":"Kapszewicz","sequence":"first","affiliation":[{"name":"Department of Endocrine Disorders and Bone Metabolism, Medical University of Lodz, 90-752 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Michalska-Kasiczak","sequence":"additional","affiliation":[{"name":"Department of Endocrine Disorders and Bone Metabolism, Medical University of Lodz, 90-752 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewa","family":"Sewerynek","sequence":"additional","affiliation":[{"name":"Department of Endocrine Disorders and Bone Metabolism, Medical University of Lodz, 90-752 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3540","DOI":"10.2174\/138161210793797915","article-title":"Glucocorticoid\u2019s Pharmacology: Past, Present and Future","volume":"16","author":"Gessi","year":"2010","journal-title":"Curr. Pharm. Des."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1002\/acr.23611","article-title":"Incidence and Risk of Glucocorticoid-Associated Adverse Effects in Patients with Rheumatoid Arthritis","volume":"71","author":"Wilson","year":"2019","journal-title":"Arthritis Care Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.ecl.2005.01.014","article-title":"Osteoporosis Associated with Excess Glucocorticoids","volume":"34","author":"Shaker","year":"2005","journal-title":"Endocrinol. Metab. Clin. N. Am."},{"key":"ref_4","first-page":"177","article-title":"Understanding and Managing Corticosteroid-Induced Osteoporosis","volume":"13","author":"Kobza","year":"2021","journal-title":"Open Access Rheumatol. Res. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1136\/jim-2018-000723","article-title":"The Impact of Low-Dose Glucocorticoids on Disease Activity, Bone Mineral Density, Fragility Fractures, and 10-Year Probability of Fractures in Patients with Rheumatoid Arthritis","volume":"66","author":"Cheng","year":"2018","journal-title":"J. Investig. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1093\/rheumatology\/39.12.1383","article-title":"Oral Corticosteroids and Fracture Risk: Relationship to Daily and Cumulative Doses","volume":"39","author":"Leufkens","year":"2000","journal-title":"Rheumatology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"174","DOI":"10.4103\/0378-6323.204202","article-title":"Effect of Intravenous Pulse Dexamethasone versus Daily Oral Prednisolone on Bone Mineral Density in Dermatology Patients: Is It a Site-Specific Response?","volume":"84","author":"Handa","year":"2018","journal-title":"Indian J. Dermatol. Venereol. Leprol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"460","DOI":"10.4103\/0019-5154.139874","article-title":"Systemic Side-Effects of Topical Corticosteroids","volume":"59","author":"Dhar","year":"2014","journal-title":"Indian J. Dermatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1001\/jamadermatol.2020.4968","article-title":"Association of Potent and Very Potent Topical Corticosteroids and the Risk of Osteoporosis and Major Osteoporotic Fractures","volume":"157","author":"Egeberg","year":"2021","journal-title":"JAMA Dermatol."},{"key":"ref_10","first-page":"144","article-title":"Bone Effects of Epidural and Intra-Articular Glucocorticoids: A Systematic Literature Review","volume":"19","author":"Brance","year":"2023","journal-title":"Actual. Osteol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e000756","DOI":"10.1136\/bmjresp-2020-000756","article-title":"Systemic Adverse Effects from Inhaled Corticosteroid Use in Asthma: A Systematic Review","volume":"7","author":"Patel","year":"2020","journal-title":"BMJ Open Respir. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1719","DOI":"10.4187\/respcare.10933","article-title":"Risk of Fracture and Osteoporosis in Patients With COPD and Inhaled Corticosteroids Treatment","volume":"68","author":"Zhang","year":"2023","journal-title":"Respir. Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"19992","DOI":"10.1074\/jbc.M001758200","article-title":"Glucocorticoids Inhibit Developmental Stage-Specific Osteoblast Cell Cycle: Dissociation of Cyclin A-Cyclin-Dependent Kinase 2 from E2F4-P130 Complexes","volume":"275","author":"Smith","year":"2000","journal-title":"J. Biol. Chem."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Gado, M., Baschant, U., Hofbauer, L.C., and Henneicke, H. (2022). Bad to the Bone: The Effects of Therapeutic Glucocorticoids on Osteoblasts and Osteocytes. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.835720"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.bbrc.2008.12.035","article-title":"BMP\/Wnt Antagonists Are Upregulated by Dexamethasone in Osteoblasts and Reversed by Alendronate and PTH: Potential Therapeutic Targets for Glucocorticoid-Induced Osteoporosis","volume":"379","author":"Hayashi","year":"2009","journal-title":"Biochem. Biophys. Res. Commun."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1210\/en.2003-0655","article-title":"Transgenic Expression of 11beta-Hydroxysteroid Dehydrogenase Type 2 in Osteoblasts Reveals an Anabolic Role for Endogenous Glucocorticoids in Bone","volume":"145","author":"Sher","year":"2004","journal-title":"Endocrinology"},{"key":"ref_17","first-page":"1752","article-title":"The Insulin-like Growth Factor-Binding Protein-4 (IGFBP-4)-IGFBP-4 Protease System in Normal Human Osteoblast-like Cells: Regulation by Transforming Growth Factor-Beta","volume":"79","author":"Durham","year":"1994","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1530\/eje.0.1340591","article-title":"Evidence for a Role for Insulin-like Growth Factor Binding Proteins in Glucocorticoid Inhibition of Normal Human Osteoblast-like Cell Proliferation","volume":"134","author":"Chevalley","year":"1996","journal-title":"Eur. J. Endocrinol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1111\/j.1749-6632.2002.tb04204.x","article-title":"Mechanisms of Glucocorticoid Action in Bone","volume":"966","author":"Canalis","year":"2002","journal-title":"Ann. New York Acad. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s00774-020-01162-6","article-title":"Osteoclast Differentiation by RANKL and OPG Signaling Pathways","volume":"39","author":"Udagawa","year":"2021","journal-title":"J. Bone Miner. Metab."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3613","DOI":"10.1210\/en.2005-0717","article-title":"Glucocorticoid Regulation of Osteoclast Differentiation and Expression of Receptor Activator of Nuclear Factor-\u03baB (NF-\u03baB) Ligand, Osteoprotegerin, and Receptor Activator of NF-\u03baB in Mouse Calvarial Bones","volume":"147","author":"Swanson","year":"2006","journal-title":"Endocrinology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1093\/rheumatology\/32.suppl_2.11","article-title":"Differential Effect of Glucocorticoids on Calcium Absorption and Bone Mass","volume":"32","author":"Gennari","year":"1993","journal-title":"Rheumatology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"4033","DOI":"10.1210\/jc.2002-012101","article-title":"The Role of Parathyroid Hormone in the Pathogenesis of Glucocorticoid-Induced Osteoporosis: A Re-Examination of the Evidence","volume":"87","author":"Rubin","year":"2002","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1002\/jbmr.5650070110","article-title":"Effects of Continuous and Intermittent Administration and Inhibition of Resorption on the Anabolic Response of Bone to Parathyroid Hormone","volume":"7","author":"Hock","year":"1992","journal-title":"J. Bone Miner. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1530\/eje.1.01841","article-title":"Chronic Glucocorticoid Treatment Alters Spontaneous Pulsatile Parathyroid Hormone Secretory Dynamics in Human Subjects","volume":"152","author":"Bonadonna","year":"2005","journal-title":"Eur. J. Endocrinol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1007\/BF00301678","article-title":"The Effect of Long-and Short-Term Corticosteroids on Plasma Calcitonin and Parathyroid Hormone Levels","volume":"54","author":"Hattersley","year":"1994","journal-title":"Calcif. Tissue Int."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/BF00675619","article-title":"Differential Effects of Glucocorticoids on Cortical Appendicular and Cortical Vertebral Bone Mineral Content","volume":"52","author":"Laan","year":"1993","journal-title":"Calcif. Tissue Int."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Umur, E., Bulut, S.B., Yi\u011fit, P., Bayrak, E., Arkan, Y., Arslan, F., Baysoy, E., Kaleli-Can, G., and Ayan, B. (2024). Exploring the Role of Hormones and Cytokines in Osteoporosis Development. Biomedicines, 12.","DOI":"10.3390\/biomedicines12081830"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1002\/jcb.1096","article-title":"Estrogen Modulates Estrogen Receptor \u03b1 and \u03b2 Expression, Osteogenic Activity, and Apoptosis in Mesenchymal Stem Cells (MSCs) of Osteoporotic Mice","volume":"81","author":"Zhou","year":"2001","journal-title":"J. Cell. Biochem."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1258\/rsmsmj.54.1.21","article-title":"Hormone Replacement Therapy (HRT) or Etidronate for Osteoporosis in Postmenopausal Asthmatics on Glucocorticoids: A Randomised Factorial Trial","volume":"54","author":"Campbell","year":"2009","journal-title":"Scott. Med. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1002\/art.1780371014","article-title":"Effect of Hormone Replacement Therapy on Bone Mass in Rheumatoid Arthritis Patients Treated with and without Steroids","volume":"37","author":"Hall","year":"1994","journal-title":"Arthritis Rheum."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1001\/jama.288.3.321","article-title":"Risks and Benefits of Estrogen plus Progestin in Healthy Postmenopausal Women: Principal Results from the Women\u2019s Health Initiative Randomized Controlled Trial","volume":"288","author":"Rossouw","year":"2002","journal-title":"JAMA"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2088","DOI":"10.1002\/art.42646","article-title":"2022 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis","volume":"75","author":"Humphrey","year":"2023","journal-title":"Arthritis Rheumatol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Shigehara, K., Izumi, K., Kadono, Y., and Mizokami, A. (2021). Testosterone and Bone Health in Men: A Narrative Review. J. Clin. Med., 10.","DOI":"10.3390\/jcm10030530"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3167","DOI":"10.1210\/jc.2002-021827","article-title":"Randomized Placebo-Controlled Trial of Androgen Effects on Muscle and Bone in Men Requiring Long-Term Systemic Glucocorticoid Treatment","volume":"88","author":"Crawford","year":"2003","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"739","DOI":"10.20945\/2359-3997000000563","article-title":"Male Osteoporosis","volume":"66","author":"Bandeira","year":"2022","journal-title":"Arch. Endocrinol. Metab."},{"key":"ref_37","first-page":"18","article-title":"GH Deficiency in the Adult and Bone","volume":"28","author":"Doga","year":"2005","journal-title":"J. Endocrinol. Investig."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"655","DOI":"10.3803\/EnM.2023.601","article-title":"Acromegaly and Bone: An Update","volume":"38","author":"Giustina","year":"2023","journal-title":"Endocrinol. Metab."},{"key":"ref_39","first-page":"122","article-title":"Effects of Recombinant Human Growth Hormone (GH) on Bone and Intermediary Metabolism in Patients Receiving Chronic Glucocorticoid Treatment with Suppressed Endogenous GH Response to GH-Releasing Hormone","volume":"80","author":"Giustina","year":"1995","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1007\/s00223-006-0019-1","article-title":"The Pathogenesis, Epidemiology and Management of Glucocorticoid-Induced Osteoporosis","volume":"79","year":"2006","journal-title":"Calcif. Tissue Int."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1210\/en.2006-0539","article-title":"Myostatin Gene Deletion Prevents Glucocorticoid-Induced Muscle Atrophy","volume":"148","author":"Gilson","year":"2007","journal-title":"Endocrinology"},{"key":"ref_42","first-page":"664","article-title":"Glucocorticoids Induce Bone and Muscle Atrophy by Tissue-Specific Mechanisms Upstream of E3 Ubiquitin Ligases","volume":"158","author":"Sato","year":"2017","journal-title":"Endocrinology"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1007\/s00198-005-1923-3","article-title":"High-Dose Glucocorticoid Treatment Induces Rapid Loss of Trabecular Bone Mineral Density and Lean Body Mass","volume":"17","author":"Natsui","year":"2006","journal-title":"Osteoporos. Int."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1007\/s12098-008-0210-7","article-title":"Pulse steroid therapy","volume":"75","author":"Sinha","year":"2008","journal-title":"Indian J. Pediatr."},{"key":"ref_45","unstructured":"Yasir, M., Goyal, A., and Sonthalia, S. (2023). Corticosteroid Adverse Effects. StatPearls, StatPearls Publishing."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1007\/BF00542348","article-title":"Corticosteroid-Induced Bone Loss. A Longitudinal Study of Alternate Day Therapy in Patients with Bronchial Asthma Using Quantitative Computed Tomography","volume":"25","author":"Medici","year":"1983","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"341","DOI":"10.20452\/pamw.1301","article-title":"Effect of Methylprednisolone Pulse Therapy with and without Alendronate on Biochemical Markers of Bone Turnover in Patients with Graves\u2019 Ophthalmopathy","volume":"122","author":"Borowska","year":"2012","journal-title":"Pol. Arch. Intern. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"4923","DOI":"10.1210\/jc.2004-0164","article-title":"Immediate Fall of Bone Formation and Transient Increase of Bone Resorption in the Course of High-Dose, Short-Term Glucocorticoid Therapy in Young Patients with Multiple Sclerosis","volume":"89","author":"Dovio","year":"2004","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1007\/s40267-024-01079-4","article-title":"Glucocorticoid-Induced Osteoporosis\u2014From Molecular Mechanism to Clinical Practice","volume":"40","author":"Hsu","year":"2024","journal-title":"Drugs Ther. Perspect."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1007\/s12020-023-03494-5","article-title":"Bone Turnover Decreases and Bone Structure Improves during Treatment with Weekly High-Dose Methylprednisolone for 12 Weeks in Graves\u2019 Orbitopathy","volume":"82","author":"Hikmet","year":"2023","journal-title":"Endocrine"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Rymuza, J., Pelewicz, K., Przedlacki, J., and Mi\u015bkiewicz, P. (2022). Therapy With Intravenous Methylprednisolone Pulses Is Associated With Loss of Bone Microarchitecture in Trabecular Bone Score -Assessment Among Patients With Moderate-to-Severe Graves\u2019 Orbitopathy: A Pilot Study. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.893600"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.trsl.2015.08.004","article-title":"Targeted Anti-Inflammatory Therapeutics in Asthma and Chronic Obstructive Lung Disease","volume":"167","author":"Durham","year":"2016","journal-title":"Transl. Res."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Oishi, K., Matsunaga, K., Yamamoto, T., Matsuda, K., Murata, Y., and Hirano, T. (2023). Practical Recommendations for a Selection of Inhaled Corticosteroids in COPD: A Composite ICO Chart. Biomolecules, 13.","DOI":"10.3390\/biom13020213"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1513\/pats.200402-016MS","article-title":"Safety of Inhaled Corticosteroids","volume":"1","author":"Tattersfield","year":"2004","journal-title":"Proc. Am. Thorac. Soc."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"59","DOI":"10.2174\/1874306401408010059","article-title":"Systemic Effects of Inhaled Corticosteroids: An Overview","volume":"8","author":"Pandya","year":"2014","journal-title":"Open Respir. Med. J."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"106374","DOI":"10.1016\/j.rmed.2021.106374","article-title":"Corticosteroids and Bone Health in People with Asthma: A Systematic Review and Meta-Analysis","volume":"181","author":"Chalitsios","year":"2021","journal-title":"Respir. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"108960","DOI":"10.1016\/j.clim.2022.108960","article-title":"The Safety of Long-Term Use of Inhaled Corticosteroids in Patients with Asthma: A Systematic Review and Meta-Analysis","volume":"236","author":"Shang","year":"2022","journal-title":"Clin. Immunol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"2130","DOI":"10.1080\/02770903.2023.2220815","article-title":"Effect of Long-Term Medium to High-Dose Inhaled Budesonide on Bone Mineral Density in Children with Asthma: A Cross-Sectional Study","volume":"60","author":"Patil","year":"2023","journal-title":"J. Asthma"},{"key":"ref_59","unstructured":"Gordon, R.J., Misra, M., and Mitchell, D.M. (2023). Osteoporosis and Bone Fragility in Children. Endotext, MDText.com, Inc."},{"key":"ref_60","unstructured":"Givan, J., Pearce, D., and Feldman, S.R. (2023). Topical Corticosteroids. Mild-to-Moderate Psoriasis, CRC Press. [2nd ed.]."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1111\/jdv.19697","article-title":"Higher Cumulative Dose of Topical Corticosteroids Is Associated with Osteoporosis and Major Osteoporotic Fracture: A Nationwide Case-Control Study","volume":"38","author":"Hsieh","year":"2024","journal-title":"J. Eur. Acad. Dermatol. Venereol. JEADV"},{"key":"ref_62","unstructured":"Patel, K., Chopra, P., Martinez, S., and Upadhyayula, S. (2024). Epidural Steroid Injections. Transforaminal Endoscopy for Lumbar Spine, Springer."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1093\/pm\/pnx324","article-title":"The Effect of Epidural Steroid Injections on Bone Mineral Density and Vertebral Fracture Risk: A Systematic Review and Critical Appraisal of Current Literature","volume":"19","author":"Kerezoudis","year":"2018","journal-title":"Pain Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1007\/s10067-002-0648-3","article-title":"Lack of Relationships between Cumulative Methylprednisolone Dose and Bone Mineral Density in Healthy Men and Postmenopausal Women with Chronic Low Back Pain","volume":"22","author":"Dubois","year":"2003","journal-title":"Clin. Rheumatol."},{"key":"ref_65","first-page":"E517","article-title":"Observational Study to Evaluate the Effect of Epidural Steroid Injection on Bone Mineral Density and Bone Turnover Markers","volume":"23","author":"Jain","year":"2020","journal-title":"Pain Physician"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Laurent, M.R., Goemaere, S., Verroken, C., Bergmann, P., Body, J.J., Bruy\u00e8re, O., Cavalier, E., Rozenberg, S., Lapauw, B., and Gielen, E. (2022). Prevention and Treatment of Glucocorticoid-Induced Osteoporosis in Adults: Consensus Recommendations From the Belgian Bone Club. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.908727"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"5","DOI":"10.5603\/EP.a2023.0012","article-title":"Guidelines for the Diagnosis and Management of Osteoporosis in Poland. Update 2022","volume":"74","author":"Sewerynek","year":"2023","journal-title":"Endokrynol. Pol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1056\/NEJMcp1012926","article-title":"Clinical Practice. Glucocorticoid-Induced Bone Disease","volume":"365","author":"Weinstein","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1089\/jwh.2010.2294","article-title":"The Fracture Risk Assessment Tool (FRAX\u00ae): Applications in Clinical Practice","volume":"20","author":"Watts","year":"2011","journal-title":"J. Womens Health"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1093\/ejendo\/lvae146","article-title":"Prevention and Treatment of Glucocorticoid-Induced Osteoporosis in Adults: Recommendations from the European Calcified Tissue Society","volume":"191","author":"Paccou","year":"2024","journal-title":"Eur. J. Endocrinol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.bone.2010.11.008","article-title":"Biochemical and Molecular Mechanisms of Action of Bisphosphonates","volume":"49","author":"Rogers","year":"2011","journal-title":"Bone"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1111\/j.1742-1241.2008.01704.x","article-title":"A Comparison of the Effect of Alendronate and Risedronate on Bone Mineral Density in Postmenopausal Women with Osteoporosis: 24-Month Results from FACTS-International","volume":"62","author":"Reid","year":"2008","journal-title":"Int. J. Clin. Pract."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1001\/archdermatol.2011.354","article-title":"Prevention of Glucocorticoid-Induced Osteoporosis in Immunobullous Diseases With Alendronate: A Randomized, Double-Blind, Placebo-Controlled Study","volume":"148","author":"Tee","year":"2012","journal-title":"Arch. Dermatol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1016\/S0140-6736(09)60250-6","article-title":"Zoledronic Acid and Risedronate in the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis (HORIZON): A Multicentre, Double-Blind, Double-Dummy, Randomised Controlled Trial","volume":"373","author":"Reid","year":"2009","journal-title":"Lancet"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1177\/1759720X09352920","article-title":"Zoledronic Acid for the Treatment and Prevention of Primary and Secondary Osteoporosis","volume":"2","author":"Rizzoli","year":"2010","journal-title":"Ther. Adv. Musculoskelet. Dis."},{"key":"ref_76","unstructured":"Ganesan, K., Goyal, A., and Roane, D. (2023). Bisphosphonate. StatPearls, StatPearls Publishing."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1111\/jcpt.13056","article-title":"Potential Risks of Rare Serious Adverse Effects Related to Long-Term Use of Bisphosphonates: An Overview of Systematic Reviews","volume":"45","author":"Lu","year":"2020","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1080\/17446651.2020.1772051","article-title":"Updates in Epidemiology, Pathophysiology and Management Strategies of Glucocorticoid-Induced Osteoporosis","volume":"15","author":"Iacopo","year":"2020","journal-title":"Expert Rev. Endocrinol. Metab."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.1002\/art.1780391104","article-title":"Recommendations for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines","volume":"39","author":"Hochberg","year":"1996","journal-title":"Arthritis Rheum."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1007\/s11657-022-01061-5","article-title":"UK Clinical Guideline for the Prevention and Treatment of Osteoporosis","volume":"17","author":"Gregson","year":"2022","journal-title":"Arch. Osteoporos."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1007\/s11914-009-0004-5","article-title":"Denosumab: Anti-RANKL Antibody","volume":"7","author":"Miller","year":"2009","journal-title":"Curr. Osteoporos. Rep."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"2843","DOI":"10.2147\/DDDT.S148654","article-title":"Denosumab in the Treatment of Glucocorticoid-Induced Osteoporosis: A Systematic Review and Meta-Analysis","volume":"13","author":"Yanbeiy","year":"2019","journal-title":"Drug Des. Dev. Ther."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/S2213-8587(18)30075-5","article-title":"Denosumab versus Risedronate in Glucocorticoid-Induced Osteoporosis: A Multicentre, Randomised, Double-Blind, Active-Controlled, Double-Dummy, Non-Inferiority Study","volume":"6","author":"Saag","year":"2018","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1136\/ard.2009.112920","article-title":"Effects of Denosumab on Bone Mineral Density and Bone Turnover in Patients with Rheumatoid Arthritis Receiving Concurrent Glucocorticoids or Bisphosphonates","volume":"69","author":"Dore","year":"2010","journal-title":"Ann. Rheum. Dis."},{"key":"ref_85","first-page":"141","article-title":"Systematic Review with Meta-Analysis: Denosumab in Glucocorticoids Induced Osteoporosis","volume":"8","author":"Ashish","year":"2021","journal-title":"Int. J. Diabetes Clin. Res."},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Liao, S.S., Deng, Y.L., Hsu, C.Y., Lee, H.T., Li, C.R., and Yang, C.C. (2025). Denosumab in the Management of Glucocorticoid-Induced Osteoporosis: Long-Term Efficacy and Secondary Fracture Outcomes. J. Clin. Med., 14.","DOI":"10.3390\/jcm14051633"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"497","DOI":"10.2147\/TCRM.S7776","article-title":"Role of Teriparatide in Treatment of Glucocorticoid-Induced Osteoporosis","volume":"6","author":"Lau","year":"2010","journal-title":"Ther. Clin. Risk Manag."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"41","DOI":"10.2147\/CE.S172820","article-title":"Anabolics in the Management of Glucocorticoid-Induced Osteoporosis: An Evidence-Based Review of Long-Term Safety, Efficacy and Place in Therapy","volume":"14","author":"Taylor","year":"2019","journal-title":"Core Evid."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"2028","DOI":"10.1056\/NEJMoa071408","article-title":"Teriparatide or Alendronate in Glucocorticoid-Induced Osteoporosis","volume":"357","author":"Saag","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1002\/jbmr.1870","article-title":"Comparative Effects of Teriparatide and Risedronate in Glucocorticoid-Induced Osteoporosis in Men: 18-Month Results of the EuroGIOPs Trial","volume":"28","author":"Marin","year":"2013","journal-title":"J. Bone Miner. Res."},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"Dong, L., Jiang, L., Xu, Z., and Zhang, X. (2024). Denosumab, Teriparatide and Bisphosphonates for Glucocorticoid-Induced Osteoporosis: A Bayesian Network Meta-Analysis. Front. Pharmacol., 15.","DOI":"10.3389\/fphar.2024.1336075"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"R46","DOI":"10.1093\/ejendo\/lvad029","article-title":"Extensive Expertise in Endocrinology: Advances in the Management of Glucocorticoid-Induced Osteoporosis","volume":"188","author":"Compston","year":"2023","journal-title":"Eur. J. Endocrinol."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s42000-023-00521-y","article-title":"\u03a4he Story of Sclerostin Inhibition: The Past, the Present, and the Future","volume":"24","author":"Anastasilakis","year":"2025","journal-title":"Hormones"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1056\/NEJMoa1708322","article-title":"Romosozumab or Alendronate for Fracture Prevention in Women with Osteoporosis","volume":"377","author":"Saag","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.1016\/S0140-6736(17)31613-6","article-title":"Romosozumab (Sclerostin Monoclonal Antibody) versus Teriparatide in Postmenopausal Women with Osteoporosis Transitioning from Oral Bisphosphonate Therapy: A Randomised, Open-Label, Phase 3 Trial","volume":"390","author":"Langdahl","year":"2017","journal-title":"Lancet"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1177\/8755122520967632","article-title":"Romosozumab: A Novel Agent in the Treatment for Postmenopausal Osteoporosis","volume":"37","author":"Miller","year":"2021","journal-title":"J. Pharm. Technol."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1007\/s00198-015-3308-6","article-title":"Sclerostin-Antibody Treatment of Glucocorticoid-Induced Osteoporosis Maintained Bone Mass and Strength","volume":"27","author":"Yao","year":"2016","journal-title":"Osteoporos. Int."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"e2778","DOI":"10.1210\/clinem\/dgae810","article-title":"Comparison of Efficacy of Romosozumab With Denosumab and Risedronate in Patients Newly Initiating Glucocorticoid Therapy","volume":"110","author":"Kawazoe","year":"2025","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1111\/joim.20017","article-title":"Romosozumab versus Denosumab in Long-Term Users of Glucocorticoids: A Pilot Randomized Controlled Trial","volume":"296","author":"Mok","year":"2024","journal-title":"J. Intern. Med."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1007\/s00198-023-06817-4","article-title":"Update on the Clinical Use of Trabecular Bone Score (TBS) in the Management of Osteoporosis: Results of an Expert Group Meeting Organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), and the International Osteoporosis Foundation (IOF) under the Auspices of WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging","volume":"34","author":"Shevroja","year":"2023","journal-title":"Osteoporos. Int."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2488\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T09:55:14Z","timestamp":1774432514000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2488"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,24]]},"references-count":100,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15072488"],"URL":"https:\/\/doi.org\/10.3390\/jcm15072488","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,24]]}}}