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

...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...