Glucocorticoid‐Induced Osteoporosis
Key Points
Key Points
- It is estimated that 1% of the US population is treated long-term with glucocorticoids (GC). However, GC use causes significant toxicity, including bone loss and fractures. More than 10% of patients who receive long-term GC treatment are diagnosed with a fracture, and 30–40% have radiographic evidence of vertebral fractures.
- The highest rate of bone loss occurs within the first 3–6 months of GC treatment, and a slower decline continues with persistent use.
- Both high daily and high cumulative GC doses increase risk of fracture, particularly vertebral fracture, due to the greater effects of GCs on trabecular bone than on cortical bone.
- In children, GC treatment also affects bone strength, growth, and total adult skeletal mass, with a similar profile of risk factors.
- If GC treatment is terminated, bone mineral density (BMD) increases and fracture risk declines.
- In addition, the absolute risk of future fracture in an individual is substantially influenced by demographic and other characteristics (age, race, sex, and concomitant osteoporosis [OP] risk factors).
- It is important to identify those patients taking GCs for whom the benefits of preventive therapy sufficiently outweigh potential harms.
Diagnosis
...Diagnos...
...racture Risk Categories in GC-Treated Patien...
...ure 1. Initial Fracture Risk Ass...
...gure 2. Reassessment of Fractur...
Treatment
Treat...
...itial Pharmacologic Treatment for Adu...
...Table 2. Recommendatio...
...adults taking prednisone at a dose of ≥2.5 mg/da...
...Adults at low risk of fractureOptimize ca...
...Adults at moderate-to-high risk of fractureTrea...
...Table 3....
...en of childbearing potential at moderate-...
...lts age ≥30 years receiving very high-dose G...
...organ transplant, glomerular filtration r...
...ren ages 4–17 years treated with GCs for ...
...4–17 years with an osteoporotic fracture who...
...Table 4. Re...
...ge ≥40 years continuing GC treatment who have...
...age ≥40 years who have completed 5 years...
...≥40 years taking an OP medication in addition to...
...age ≥40 years taking an OP medication in...