Clinical Question: What is the best approach to managing glucocorticoid-induced osteoporosis?
Article first published online: 7 APR 2011
© 2011 Blackwell Publishing Ltd
Volume 74, Issue 5, pages 547–550, May 2011
How to Cite
Compston, J. (2011), Clinical Question: What is the best approach to managing glucocorticoid-induced osteoporosis?. Clinical Endocrinology, 74: 547–550. doi: 10.1111/j.1365-2265.2011.03994.x
- Issue published online: 7 APR 2011
- Article first published online: 7 APR 2011
- Accepted manuscript online: 29 JAN 2011 05:05AM EST
- (Received 29 December 2010; returned for revision 20 January 2011; finally revised 24 January 2011; accepted 24 January 2011)
Glucocorticoid-induced osteoporosis is common, and the resulting fractures cause significant morbidity and mortality. Rapid bone loss and increased fracture risk occur soon after the initiation of glucocorticoid therapy and are dose dependent. The increase in fracture risk is partly independent of bone mineral density, probably as a result of changes in bone material properties and increased risk of falling. Fracture risk can be assessed using the FRAX® algorithm, although risk may be underestimated in patients taking higher doses of glucocorticoids. Because of the rapidity of bone loss and increase in fracture risk after the start of glucocorticoid therapy, primary prevention should be advised in high-risk individuals, for example older women and men, individuals with a previous fracture history and those with low bone mineral density. Bisphosphonates are the front-line choice for the prevention of fracture in the majority of glucocorticoid-treated patients, with teriparatide as a second-line option. Calcium and vitamin D supplements should be co-prescribed unless there is evidence of an adequate dietary calcium intake and vitamin D status.