Fact Sheet

Glucocorticoid-Induced Osteoporosis

  • Editors
  • Jens Bollerslev, MD
    Steven T. Harris, MD
    Benjamin Z. Leder, MD

What is glucocorticoid-induced osteoporosis?

Glucocorticoid-induced osteoporosis (GIO) is a condition in which people who take medicines called glucocorticoids develop osteoporosis—weakening of the bones.  Osteoporosis increases the risk of broken bones (fractures).

Glucocorticoids are synthetic (manufactured) hormones also known as steroids.  They include medicines such as prednisone, cortisone, hydrocortisone, and dexamethasone.

Common conditions treated with glucocorticoids include

Glucocorticoids can be taken as a pill (by mouth), an injection under the skin or in a vein, a nasal spray or inhaler, or even as a skin ointment or cream.

Did you know?

Glucocorticoids given by mouth, by vein, or by skin injection are most likely to cause GIO.

What causes GIO?

Normally, your body continuously removes old bone and replaces it with new bone.  However, glucocorticoids can increase the breakdown of bone and decrease the formation of new bone.  This can cause your bones to weaken.  Weak bones can break easily when you have a minor fall (called a fragility fracture).  Some people break bones for no reason at all.  Bone fractures can be serious and painful.  They can affect your ability to move, walk, and care for yourself.

Glucocorticoids start to weaken your bones during the first 3 months of use.  The rate of bone loss is greatest within the first 6 months of treatment, but continues as long as you take glucocorticoids.  The higher your dose, the greater your risk of GIO.  But even low doses can cause GIO over time.  Therefore, experts recommend that doctors prescribe the smallest possible dose for the shortest period of time.  

Who is most at risk for GIO?

Some people who take glucocorticoids are at greater risk for GIO:

How will you know whether your bones are weak?

A bone mineral density test (also called a DXA test) measures the strength of your bones.  This simple, painless test uses low-dose x-rays to help predict your chances of having a fracture.  Your doctor also may check your spine for fractures using x-rays or an MRI (magnetic resonance imaging) test. 

How can you reduce your risk of GIO?

If you’ll be taking glucocorticoids for 3 months or longer, you can lower your risk of GIO by following these steps:

Experts also suggest taking calcium and vitamin D supplements, even if you’re taking glucocorticoids for less than 3 months.  Your doctor can tell you how much to take.  Your doctor also may check your risk of falling and provide advice about how to prevent falls.  People who are especially at risk for osteoporosis will need medicine. 

Who will need medicine to protect their bones?

Your doctor will review your medical history, current condition, and glucocorticoid dose to determine your risk.  Experts recommend bone-protective medicine for certain groups who are taking glucocorticoids for at least 3 months:

The following groups also might need medicine to protect their bones:

Which types of medicines help protect bones?

Two types of medicines are available.  Your doctor will prescribe the type of medicine that’s best for you. 

Ask your doctor if you need a DXA test and how much calcium and vitamin D you should take.  If you need medicine to protect your bones, talk with your doctor about how long you should take it, what side effects you might have, and any other questions that concern you.

Questions to ask your doctor


Find-an-Endocrinologist: or call 1-800-HORMONE (1-800-467-6663)

Hormone Health Network information on osteoporosis:

National Institutes of Health (NIH) Osteoporosis and Related Bone Diseases National Resource Center:

Mayo Clinic:

The National Osteoporosis Foundation: