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ACR releases updated recommendations for glucocorticoid-induced osteoporosis
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The American College of Rheumatology has released an updated guideline for the treatment of patients with glucocorticoid-induced osteoporosis, according to a press release.
“This guideline provides direction for clinicians and patients in making treatment decisions about management decisions in patients with or at risk for [glucocorticoid-induced osteoporosis] GIOP,” Lenore Buckley, MD, MPH, principal investigator of the guideline, said in the release.
Buckley and colleagues performed a systematic review and used Grading of Recommendations Assessment, Development and Evaluation methodology to rate evidence quality and make their recommendations.
According to the release, the following are strong recommendations for all age groups:
- For all patients, optimize calcium and vitamin D consumption and implement lifestyle changes, such as weight-bearing and strength-building exercise, smoking cessation and limit alcohol; and
- For men and for women not of childbearing potential who have a moderate to high risk for fracture, treat with oral bisphosphonates, intravenous bisphosphonates, teriparatide or denosumab. For postmenopausal women for whom none of these medications are appropriate, treat with raloxifene.
For special populations, the following are conditional recommendations:
- For adult women of childbearing potential at moderate to high risk of fracture and who are not planning a pregnancy during treatment, treat with oral bisphosphonates. If this is unsuccessful, treat with teriparatide;
- For patients who underwent solid organ transplant, are continuing glucocorticoid treatment and have a glomerular filtration rate of greater than 30, treat according to age-group recommendations. In addition, evaluate patients who underwent renal transplant for metabolic bone disease and in patients on multiple immunosuppressive agents, avoid denosumab;
- For patients aged 4 years to 17 years, optimize calcium and vitamin D intake and add oral bisphosphonates if the child had an osteoporotic fracture and is undergoing glucocorticoid therapy for at least 0.1 mg/kg for at least 3 months. Use intravenous bisphosphonates if oral treatments are not appropriate; and
- For patients who are treated with at least 30 mg of prednisone and more than a cumulative dose of 5 g per year and are at least 30 years old, treat with oral bisphosphonates.
For special considerations in osteoporosis treatment, the guideline recommended the following:
- For those who failed treatment or had a fracture after 18 months of oral bisphosphonates or who had a bone mineral density loss of more than 10% in 1 year, treat with teriparatide or denosumab. If the failure is due to poor adherence or absorption, use intravenous bisphosphonates;
- Continue active treatment for patients who have completed oral bisphosphonate treatment but remain at high risk for fracture; and
- For patients who have discontinued glucocorticoids, halt osteoporosis treatment if reassessment suggests they are at low risk for fracture or complete treatment if they are at moderate to high risk.
“Clinicians and patients should employ a shared decision-making process that accounts for patients’ values, preferences and comorbidities,” Buckley said.
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