Effectiveness of Anti-Osteoporotic Medications in the Management of Glucocorticoid-Induced Osteoporosis: A Systematic Review and Network Meta-Analysis on Behalf of the ECTS Clinical Action Group.

Authors

Maria P Yavropoulou, Marieke M Ter Wee, Anda Mihaela Naciu, Julien Paccou, Athanasios D Anastasilakis, Chrysoula G Gialouri, Barbara Hauser, Anne Sophie Sølling, Stella D'Oronzo, Tim Rolvien, Willem F Lems

Published in

European journal of endocrinology. Aug 07, 2026. Epub Aug 07, 2026.

Abstract

To evaluate and compare the efficacy of anti-osteoporotic-medications (AOM) for the prevention and treatment of glucocorticoid-induced-osteoporosis (GIOP).
Systematic review and network-meta-analysis conducted in accordance with PRISMA-NMA guidelines (ProsperoID:CRD42024502298).
MEDLINE, Embase, and Web of Science were searched from inception to December 2025 to identify randomized-controlled-trials and comparative-observational-studies evaluating AOM in adults receiving oral glucocorticoids (GC). Outcomes included percentage change in areal bone- mineral-density (aBMD) at the lumbar-spine (primary), femoral-neck, and total-hip. A random effects network-meta-analysis was performed, integrating direct and indirect comparisons across AOM. Certainty of evidence was assessed using the CINeMA framework.
Thirty-one studies (28 randomized-controlled-trials and 3 observational-studies) involving 5,260 participants (age-range:29.6-70.6years, 72.5%females) were included. All AOM were superior to placebo or calcium/vitaminD supplementation in increasing lumbar-spine aBMD. Teriparatide demonstrated the greatest efficacy compared with alendronate (effect-size:3.8;95%CI:2.9-4.6), risedronate (4.0;95%CI:2.9-5.1), denosumab (1.5;95%CI:0.1-2.9), and zoledronate (2.4;95%CI:1.1-3.6), while no significant difference was observed with romosozumab (0.3;95%CI:-2.1 to 1.4). Among antiresorptive-medications, zoledronate and denosumab showed greater efficacy than oral bisphosphonates, which demonstrated modest positive effects. In sensitivity analyses restricted to established GIOP, defined as GC users ≥3months, teriparatide and romosozumab remained superior to antiresorptive-medications. Evidence for total-hip and femoral-neck aBMD outcomes was limited by substantial network inconsistency (mostly missing data). Included studies were underpowered to assess difference in fracture outcomes.
This network-meta-analysis demonstrates a clear gradient of efficacy among AOM in GIOP, with anabolic and potent antiresorptive-medications producing the largest gains in lumbar- spine aBMD supporting current ECTS recommendations advocating risk-stratified treatment selection.

PMID:
42565501
Bibliographic data and abstract were imported from PubMed on 07 Aug 2026.

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