Clinical Rheumatology · Nov 6, 2026

Glucocorticoid-induced osteoporosis in patients with rheumatic diseases: clinical characteristics, associated factors, and fragility fractures

By Ok NF, Duruöz MT, Gezer HH

Background Glucocorticoids (GCs) are widely used in the treatment of rheumatic diseases because of their potent anti-inflammatory and immunosuppressive effects. However, prolonged GC exposure is associated with glucocorticoid-induced osteoporosis (GIOP) and an increased risk of fragility fractures. Objectives To determine the prevalence of reduced bone mineral density (BMD) and densitometric osteoporosis and to investigate factors associated with BMD and fragility fractures in patients with rheumatic diseases receiving GC therapy. Methods This cross-sectional medical records review study included 223 patients with rheumatic diseases receiving GC therapy who underwent osteoporosis screening. Clinical characteristics, GC exposure, fragility fractures, laboratory parameters and femoral neck and lumbar spine dual-energy X-ray absorptiometry (DXA) results were recorded. Patients were classified by the lowest T-score using World Health Organization criteria as normal (T-score > − 1.0), osteopenia (− 2.5 < T-score ≤ − 1.0) or osteoporosis (T-score ≤ − 2.5); reduced BMD denoted osteopenia or osteoporosis. Multivariable logistic regression identified factors independently associated with fragility fractures. Results Mean age was 59.9 ± 10.9 years; 93.3% were female. Rheumatoid arthritis was the most common diagnosis (54.3%). Among 214 patients with available DXA classification, 16.4% had normal BMD, 55.6% osteopenia and 28.0% osteoporosis; thus, 83.6% had reduced BMD. Patients with reduced BMD were older, had longer disease duration, longer GC treatment duration and higher cumulative GC exposure than those with normal BMD (p < 0.05). T-scores were inversely correlated with age, disease duration, GC treatment duration, daily GC dose and parathyroid hormone levels (all p < 0.05). Fragility fractures occurred in 38.1% of patients, and 67.9% of those with fractures and available DXA classification had normal BMD or osteopenia rather than densitometric osteoporosis. In multivariable logistic regression analysis, older age (OR 1.22 per year, 95% CI 1.15–1.29), female sex (OR 10.40, 95% CI 1.14–94.84) and longer disease duration (OR 1.07 per year, 95% CI 1.01–1.13) were independently associated with fragility fractures. Conclusion Reduced BMD was common among patients with rheumatic diseases receiving long-term GC therapy and was associated with older age, longer disease duration and greater GC exposure. Most fragility fractures occurred in patients without densitometric osteoporosis, suggesting that BMD alone may not fully reflect fracture risk in this population. Key points • Reduced BMD (T-score ≤ − 1.0) was present in 83.6% of patients with rheumatic diseases receiving long-term GC therapy, whereas densitometric osteoporosis (T-score ≤ − 2.5) was present in 28.0%. • Fragility fractures were frequent, and approximately two-thirds of patients with fractures did not have densitometric osteoporosis. • Older age, female sex and longer disease duration were independently associated with fragility fractures, highlighting the need for fracture risk assessment beyond BMD alone.

doi.org/10.1007/s10067-026-08521-0PubMed 42993377Populations