2010 Recommendations for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis
Grossman JM, Gordon R, Ranganath VK, et al. American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res (Hoboken) 2010 Nov;62(11):1515-26. doi: 10.1002/acr.20295. Epub 2010 Jul 26. PMID: 20662044.
By Kim L. Farina, PhD
Glucocorticoids are used to manage many inflammatory conditions, but they are not without side effects. One of these side effects, glucocorticoid-induced osteoporosis (GIOP), may result in fractures, pain, and disability. More than 1 million patients in the United States receive a prescription for glucocorticoids every year. Because of the extensive use and the possible side effects of this class of drugs, the American College of Rheumatology (ACR) published new recommendations that address clinical issues pertaining to adult patients undergoing oral glucocorticoid therapy.1 State-of-the-art, validated, guideline-development methodology was applied in the development of the recommendations. This effort was led by a team of investigators from the University of California, Los Angeles, in collaboration with investigators from the University of Alabama at Birmingham (UAB) Deep South Musculoskeletal Centers for Education and Research on Therapeutics. The recommendations were reviewed and endorsed by the American Society for Bone and Mineral Research.
Since the previous recommendations were published in 2001, there have been numerous developments that warranted their reappraisal and update, including the emergence of new data and therapies, the adoption of new approaches to identify the patients at highest risk for fracture, and more rigorous processes for guideline development.
Noteworthy changes to the 2011 recommendations, which were published in the November 2010 issue of the ACR's official journal, Arthritis Care & Research, include:
- New pharmacologic recommendations that are delineated for patient subpopulations by specific criteria such as childbearing potential, age, gender, and history of fragility fracture.
- Inclusion of the newer therapies, zoledronic acid and teriparatide, along with alendronate or risedronate, for the treatment of GIOP.
- Estrogen-replacement and testosterone therapies are no longer endorsed.
- Expansion of the discussion points relating to behavior modification, monitoring, and prevention counseling to include: an assessment of fall risk; measurements of height and 25-hydroxyvitamin D; an evaluation for prevalent and incident fragility fractures; and consideration0f vertebral fracture assessment or radiographic imaging of the spine, as well as supplementation with calcium and vitamin D, for any duration of glucocorticoid use.
- Incorporation of the FRAX (Fracture Risk Assessment Tool) score or the patient's overall clinical risk profile, rather than the use of T-score alone, because bone mineral density may not be a relevant risk factor for fracture among patients with GIOP when compared with other forms of osteoporosis.
The full 2010 recommendations and an abbreviated clinician's guide are available at www.rheumatology.org by clicking on "Practice Management" and then "Practice Guidelines."