United States Adults Meeting 2010 American College of Rheumatology Criteria for Treatment and Prevention of Glucocorticoid‐Induced Osteoporosis

Abstract

Objective. The American College of Rheumatology (ACR) updated its guidelines on the prevention and treatment of glucocorticoid-induced osteoporosis (GIO) in 2010. An unknown proportion of US adults at risk of fracture due to glucocorticoid use would be recommended antiosteoporosis pharmaceutical (AOP) therapies based on the ACR guidelines. Methods. Using the 2005-2010 National Health and Nutrition Examination Survey (NHANES) data for postmenopausal women (PMW), and men age >50 years reporting current glucocorticoid use, we categorized individuals according to ACR criteria for low, medium, and high fracture risk (<10%, >10%, and >20%, respectively) and provided percentages of treatment recommendations for chronic (>90 days) medium and all high-risk patients. Results. Glucocorticoids were used by 1.66% of PMW and 1.65% of men age >50 years. Of these patients, 0.80% of PMW and 0.45% of men age >50 years were at high risk of fracture. A majority of PMW (81.2%) and men age >50 years (75.8%) were chronic glucocorticoid users. In patients for whom treatment recommendations could be made, 64.9% of PMW and 51.9% of men age >50 years would be recommended therapy, but only 28.4% of PMW and 9.7% of men age >50 years reported AOP use. Conclusion. Based on the NHANES (2005-2010) data, we estimate glucocorticoid use in >1.5 million US PMW and men age >50 years. Treatment would be recommended in at least 50% of this population based on the 2010 ACR guidelines. Self-reported AOP use was documented in <30%, suggesting a treatment gap in the management of GIO in the US before the guideline release.

Risk factors for osteoporosis and factors related to the use of DXA in Norway

“…The uptake of DXA in this population was 61.0 and 30.1 %, respectively. Rates of reported current or previous GC treatment was in concord with previously reported rates from Denmark (4.5 % among women, [12]) and also comparable to earlier reported rates of previous (4.5 % [24]) and current reported CG use of 0.5-1.2 % [25]. Uptake of DXA among women reporting CG treatment was higher than the 52.3 % reported by Rubin et al for women [12] and higher than reported rates for men in Denmark of 10-15 % [13].…”

miR-216a rescues dexamethasone suppression of osteogenesis, promotes osteoblast differentiation and enhances bone formation, by regulating c-Cbl-mediated PI3K/AKT pathway

“…It has been reported that long-term administration of glucocorticoids can lead to GIO. 35 Glucocorticoids suppress bone formation through their direct and indirect effects on osteoblasts.…”

Aberrant REDD1-mTORC1 responses to insulin in skeletal muscle from Type 2 diabetics

“…Despite the principal role of REDD1 in glucocorticoid function and the prevalent use of glucocorticoids by insulin-resistant cohorts (e.g., obese, T2D, aged) (56,57), little has been established about REDD1 in relation to insulin action. Moreover, the same stressors that upregulate REDD1 expression, such as glucocorticoids (75), DNA damage (42), endoplasmic reticulum stress (61,76), and hypoxia (7,65), are the same stressors that are observed in obese individuals (1,16,47) and inhibit mTOR function (7,23,75).…”