Glucocorticoid‐Induced Osteoporosis

Publication Date: June 26, 2017

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

...Diagnosis

...re Risk Categories in GC-Treated Patients...


...nitial Fracture Risk Assessment...


...Reassessment of Fracture Risk


Treatment

...Trea...

...re 3. Initial Pharmacologic Treatment for Ad...


...Table 2. Recomm...

...ll adults taking prednisone at a dose o...

...lts at low risk of fractureOptimize calci...

...moderate-to-high risk of fractureTreat...


...Table...

...omen of childbearing potential at moderate-to-h...

...≥30 years receiving very high-dose...

...with organ transplant, glomerular filtration r...

...s 4–17 years treated with GCs for ≥3 monthsOpt...

...hildren ages 4–17 years with an os...


...Table 4. Recommend...

...e ≥40 years continuing GC treatment who hav...

...40 years who have completed 5 years of oral...

...≥40 years taking an OP medication...

...s age ≥40 years taking an OP medic...