Glucocorticoid-induced osteoporosis; management based on recent major international recommendations

Osteoporosis is one of the important adverse effects of glucocorticoids causing significant disability due to fractures. Fracture is the presenting feature in 30-50% of patients with Glucocorticoid-Induced Osteoporosis (GIO). A rapid decline in bone mineral density (BMD) occurs in the first six months with the use of glucocorticoids.

We discuss the management strategies available to prevent and treat GIO based on the American College of Rheumatology (ACR) Guidelines (2010), American Society of Bone Mineral Research (ASBMR) recommendations (2011) and International Osteoporosis Foundation (IOF) Guidelines (2012).

All three guideline committees recommend counseling for lifestyle modification, risk assessment and adequate calcium and vitamin D supplementation.

The ACR expert panel has recommended the FRAX tool for the risk stratification. It considered the glucocorticoid dose as an average dose. However, there is strong evidence that the risk associated with glucocorticoid use is dose related. Considering that, IOF proposed a FRAX adjustment for the dose of glucocorticoids.

Even though there is evidence for the bisphosphonate therapy for patients with more than 50 years of age, there is a significant paucity of evidence for age less than 50 years group. ACR only recommends bisphosphonate therapy for the patients below 50 years with fragility fractures. But ASBMR recommends bisphosphonate therapy for patients below 50 years with Z -score less than – 2 or if there is a significant risk of BMD loss. But the IOF has recommended the use of bisphosphonates based on clinical background and adjusted FRAX score.

DOI: http://dx.doi.org/10.4038/sjdem.v3i2.6366

Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2013; 3: 80-83