Suggested Guidelines for Evaluation and Treatment of Glucocorticoid-Induced Osteoporosis for the Department of Veterans Affairs

Abstract

Attention to fracture risk assessment in patients undergoing glucocorticoid therapy and timely bisphosphonate treatment should lead to fewer fractures.

Barriers in the management of glucocorticoid‐induced osteoporosis

“…Our findings were similar to those of previous reports demonstrating that health care providers do a suboptimal job in preventing and treating GIOP (7)(8)(9)(10)(11). As in previous studies, COPD and rheumatoid arthritis were the most common diagnoses for which glucocorticoids were prescribed, and internal medicine specialists and primary care providers were the most common prescribers of glucocorticoid medications (8,10,12,13).…”

“…Clinical guidelines are available for the prevention and management of GIOP, including those provided by the American College of Rheumatology (ACR) (6) and by Adler and Hochberg (7). Current ACR guidelines recommend that all patients beginning therapy with glucocorticoids (prednisone equivalent Ն5 mg/day) with a planned treatment duration of Ն3 months should be counseled on modification of lifestyle risk factors for osteoporosis, given calcium plus vitamin D supplementation, and started on bisphosphonate therapy.…”

The Effect of Long Term Administration of Glucocorticoid to Bone Lining Cells Apoptosis

“…Glucocorticoid therapy can save many lives, however its long term administration can cause life-threatening side effects, one of them is bone mass loss which increases the risk of bone fractures (Adler 2003, Dvorak 2006. Epidemiologic data suggests that glucocorticoid therapy can double the risk of femur and distal radius fractures and even four times higher risk for spine fractures.…”

“…The main reason for that is the fact that long term glucocorticoid therapy can induce rapid and severe bone loss which eventually heightens the risk of fractures. An analysis of General Practice Research Database (UK) at Veterans Affair Medical Centers shows that 40% of respiratory patients who underwent glucocorticoid therapy with daily dosage addition were facing a relative increased risk of femur and spine fractures (Abu 2000, Adler 2003, Takuma 2003, Jia 2006, Kim 2006, Swanson 2006, Lu 2007.…”

Cross-sectional Study of Bisphosphonate Use in Dermatology Patients Receiving Long-term Oral Corticosteroid Therapy

“…6 Meanwhile, a suggested guideline for osteoporosis prophylaxis in the Veterans Affairs population sets the prednisone dose of at least 7.5 mg/d as the threshold for bisphosphonate therapy. 7 For our study, we examined patients who were receiving at least a 10-mg/d dose of predni- sone or an equivalent drug. There is international agreement that all patients receiving glucocorticoid therapy should also receive calcium and vitamin D supplementation, whether or not they are treated with bisphosphonates.…”