Clinical Research Directory

Inclusion Criteria: * Women and men, age 18 years or older and able to provide informed consent (IC) * ≥ 3 months of glucocorticoid use at \> 7.5 mg /day (prednisone equivalent dose) and anticipated to remain on glucocorticoids for at least six months * A baseline BMD T-score of ≤ -2.0 at the lumbar spine, total hip, or femoral neck; OR * A BMD T-score ≤ -1.0 at the lumbar spine, total hip, or femoral neck and a history of an osteoporotic fracture. Exclusion Criteria: * • Patients with fewer than three lumbar vertebrae that could be evaluated on dual energy x-ray absorptiometry (DXA) * Treatment with bisphosphonates in the preceding 2 years * Greater than 24 months (\>4 injections) of prior treatment with denosumab * Women of childbearing potential, who are not currently using birth control, are pregnant, planning to become pregnant, or are breastfeeding. For women of childbearing potential: refusal to use 2 highly effective forms of contraception and to continue this practice for 7 months after last injection of study medication\* * Men planning to conceive in the next 12 months * Unstable systemic medical condition * Uncontrolled hyperthyroidism * Uncontrolled hypothyroidism * History of Addison disease * History of osteomalacia * History of osteonecrosis of the jaw (ONJ) * History of atypical femur fracture * History of tooth extraction, jaw surgery, dental implants, or other dental surgery within the prior 6 months * History of anorexia nervosa, bulimia (by history or physical) or obvious malnutrition. * Invasive dental work(implants/surgery) planned in the next 2 years * History of Paget's disease of bone * Other bone diseases which affect bone metabolism * Vitamin D deficiency \[25(OH) vitamin D level \< 20 ng/mL (\<49.9 nmol/L)\] * Hypercalcemia \>10% above upper limit of normal (ULN) * Elevated transaminases or total bilirubin ≥ 2.0 x ULN * History of any solid organ or bone marrow transplant * Malignancy within the last 5 years (except cervical carcinoma in situ or basal cell carcinoma or localized squamous cell carcinoma of the skin) * Hypocalcemia \<10% below lower limit of normal (LLN) * Estimated glomerular filtration rate \< 30 mL/minute/1.73 m\^2 * Intolerance to calcium supplements, vitamin D supplements * Contraindication to, or poorly tolerant of denosumab therapy (including hypersensitivity to the drug) * Contraindication to, or poorly tolerant of zoledronic therapy (including hypersensitivity to the drug) * Contraindication to, or poorly tolerant of alendronate (including hypersensitivity to the drug and sever gastro-intestinal intolerance to oral bisphosphonates) * Recipient of an investigational drug within 4 weeks prior to study drug administration * Not a good candidate for study participation in opinion of investigator