#2-07E. Optimizing GIO Management: Sequential Therapy and Anabolic Agents (LDE, 2025)

Glucocorticoid (GC) therapy is a necessary cornerstone in managing numerous immune-mediated diseases, but how do we effectively mitigate the serious risk of fragility fractures associated with chronic use? This comprehensive review meticulously examines glucocorticoid-induced osteoporosis (GIO), detailing how GC excess directly suppresses osteoblast and osteocyte function, impairs bone microarchitecture, and causes adverse metabolic changes that culminate in severe skeletal fragility. The authors highlight the molecular pathogenesis, current diagnostic steps, including risk assessment tools like FRAX and dual-energy X-ray absorptiometry (DXA), and explore established and emerging therapeutic strategies. Crucially, the review posits that for patients with severe GIO, the most rational long-term strategy is sequential therapy, initiating with potent bone-anabolic agents followed by antiresorptive drugs. A critical point for clinicians, however, is that much of the existing evidence for fracture reduction with pharmacological interventions relies heavily on post-hoc analyses of randomized controlled trials or observational data, underscoring the need for more robust prospective studies. Since GIO is the most common iatrogenic form of osteoporosis, understanding these novel treatment concepts is vital for clinicians to implement individualized, modern therapeutic sequences, thereby optimizing care for high-risk patients in daily clinical practice.

Citation: Hofbauer LC, Compston JE, Saag KG, Rauner M, Tsourdi E. Glucocorticoid-induced osteoporosis: novel concepts and clinical implications. Lancet Diabetes Endocrinol. 2025. DOI: https://doi.org/10.1016/S2213-8587(25)00251-7

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