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
...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...