Update in Diagnosis and Management of Glucocorticoid-Induced Osteoporosis

Glucocorticoid-induced osteoporosis (GIOP) is a significant clinical challenge characterized by a rapid increase in fracture risk following glucocorticoid (GC) initiation. GCs disrupt bone homeostasis by accelerating resorption and suppressing formation. Recent evidence identifies that the GC dosage associated with fracture risk may be lower than previously reported. Assessment should integrate clinical risk factors with advanced tools such as GC-adjusted FRAX, vertebral fracture assessment (VFA), and trabecular bone score (TBS), as fractures often occur at higher bone mineral density levels than in postmenopausal osteoporosis. International guidelines now advocate for earlier intervention and lower treatment thresholds. While bisphosphonates remain the first-line standard treatment, anabolic agents are increasingly prioritized for very high-risk patients. Ultimately, a holistic approach involving proactive screening and early pharmacological intervention is essential to reduce the burden of GIOP and preserve skeletal integrity in patients requiring long-term GC therapy. This review highlights recent updates in the diagnosis and management of GIOP.