There are now several excellent studies demonstrating the effectiveness of bisphosphonate therapy in preventing or treating GIOP in both men and women. Two randomized studies34,35 showed that etidronate disodium given in cyclic fashion (400 mg orally daily for 2 weeks every 3 months) could prevent bone loss and vertebral fracture in patients just starting glucocorticoids at doses of 7.5 mg of prednisone or more. In more recent studies of newer bisphosphonates, alendronate sodium36,37 and risedronate sodium38,39 have been shown to successfully prevent and treat GIOP. In the alendronate study,36 the relative risk of spine fracture defined by morphometric analysis of x-ray films was 0.6 in the men and women taking alendronate. In the 2-year blinded extension,37 continued alendronate therapy was shown to dramatically decrease the incidence of morphometric vertebral fractures. In a study of risedronate in patients receiving long-term glucocorticoid therapy,38 the vertebral fracture rate was decreased by 70% in 1 year in men and women who received risedronate. This was confirmed by another randomized, controlled, double-blinded study39 of risedronate in patients beginning glucocorticoid therapy. Thus, there is high-quality evidence that bisphosphonate therapy can decrease fracture risk and increase bone density in patients about to start glucocorticoid therapy and in patients already taking prednisone or its equivalents. The FDA has approved alendronate for treatment of GIOP. The approved dose is 5 mg/d, except for postmenopausal women not receiving hormone replacement therapy, for whom the approved dose is 10 mg/d. Risedronate sodium at 5 mg/d is FDA approved for both prevention and treatment of GIOP. Trials of alendronate sodium, 70 mg once weekly, and risedronate sodium, 35 mg once weekly, in GIOP are currently in progress. A recent study40 suggests that intravenous pamidronate disodium may be used as an alternative to oral bisphosphonates to prevent GIOP, but this is not FDA-approved therapy. A summary of bisphosphonate treatment regimens that have not yet received FDA approval is listed below.