ACR Releases Guideline on prevention and treatment of glucocorticoid-induced osteoporosis

June 8, 2017

The American College of Rheumatology's (ACR) updated clinical guideline for the prevention and treatment of glucocorticoid-induced osteoporosis is now available online. The guideline provides recommendations on assessing fracture risk and treatment for adults and special patient populations including women of childbearing potential, adults treated with very high-dose glucocorticoids, adults with organ transplants, and children ages 4-17.

"The guideline provides direction for clinicians and patients in making treatment decisions about management decisions in patients with or at risk for GIOP," said principal investigator Lenore Buckley, MD, MPH. "Clinicians and patients should employ a shared decision-making process that accounts for patients' values, preferences and comorbidities."

For all age groups, the panel's strong recommendations are:

  • Optimize calcium and vitamin D intake and implement lifestyle modifications, such as weight-bearing and strength-building exercise, smoking cessation and limiting alcohol intake.
  • Treat men and women not of childbearing potential at moderate to high fracture risk with, in order of preference, oral bisphosphonates, IV bisphosphonates, teriparatide, denosumab. Raloxifene is recommended for postmenopausal women for whom none of the other medications are appropriate.

For special populations, conditional recommendations are:

  • For adult women of childbearing potential at moderate to high risk who are not planning a pregnancy during osteoporosis treatment, treat with oral bisphosphonates; if an alternate option is needed due to lack of success with oral bisphosphonates, choose teriparatide, because of its short duration of action.
  • For solid who are continuing glucocorticoid treatment and have a GFR (glomerular filtration rate) >30, treat according to the recommendations for their age group. Evaluate renal transplant patients for metabolic bone disease, and avoid denosumab due to the lack of data about infection risk in people on multiple immunosuppressive agents.
  • For children 4-17 years old, optimize calcium and vitamin D intake, and add oral bisphosphonates if the child has sustained an osteoporotic fracture and is continuing glucocorticoids at ?0.1 mg/kg for ?3 months. Use IV bisphosphonates if oral treatments are not appropriate for these patients.
  • For patients who are treated with very high-dose glucocorticoids (?30 mg of prednisone and a cumulative dose of >5 g in a year) and are age 30 or older, treat with oral bisphosphonates.

Special considerations during osteoporosis treatment include:

  • For those who fail treatment or have a fracture after 18 months of oral or have a significant BMD loss of more than 10 percent a year, treat with teriparatide or denosumab, or use IV bisphosphonates if failure is due to poor adherence or absorption.
  • For patients who have completed oral bisphosphonate treatment but remain at high fracture risk, continue an active treatment.
  • For who have discontinued , stop osteoporosis treatment if reassessment shows they are now at low risk, or complete the treatment if they are at moderate to high risk for fracture.

The ACR first published GIOP recommendations in 1996 and has updated these guidelines (first in 2001, then again in 2010) as new techniques for assessing and new information about risk factors and therapies became available. For this new guideline, a systematic literature review was conducted to synthesize the evidence for the benefits and harms of GIOP prevention and options. The committee used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the quality of evidence. A group consensus process was then used to determine the final recommendations and their grade strength.

The complete guideline is available on the ACR website at: https://www.rheumatology.org/Practice-Quality/Clinical-Support/Clinical-Practice-Guidelines/Glucocorticoid-Induced-Osteoporosis.

Explore further: ACP issues guideline for treating low bone density or osteoporosis to prevent fractures

Related Stories

ACP issues guideline for treating low bone density or osteoporosis to prevent fractures

May 8, 2017
The American College of Physicians (ACP) recommends in an evidence-based clinical practice guideline published today in Annals of Internal Medicine that physicians treat women with osteoporosis with bisphosphonates (alendronate, ...

Benefits and harms of osteoporosis medications unclear for patients with CKD

April 10, 2017
More research is needed to determine the benefits and harms of osteoporosis medications on bone mineral density (BMD), fracture risk, and safety among patients with chronic kidney disease (CKD). This is important because ...

Specific long-term therapy may not prevent fractures in older women

June 2, 2017
Osteoporosis is a disease that causes thinning of the bones, loss of bone density, and increasingly fragile bones. This puts people at higher risk for bone fractures. Risk for the disease increases as we age. In fact, 50% ...

Most people at risk for osteoporisis fractures are not evaluated and treated

November 28, 2016
Osteoporosis is preventable and treatable, but only a small proportion of people at risk for fractures are evaluated and treated, according to new osteoporosis guidelines written by an expert panel headed by Loyola Medicine ...

Task force provides guidance on use of osteoporosis drugs

January 19, 2016
A new report by a Task force of the American Society for Bone and Mineral Research provides guidance on the use of bisphosphonates, which are the most commonly used medications for osteoporosis.

Osteoporosis screening and treatment fall short for women with hip fractures

February 23, 2017
It's important to identify and treat osteoporosis following hip fracture, but a large study found low rates of assessment and treatment in postmenopausal women who had suffered a hip fracture.

Recommended for you

Four simple tests could help GPs spot pneumonia and reduce unnecessary antibiotics

November 23, 2017
Testing for fever, high pulse rate, crackly breath sounds, and low oxygen levels could be key to helping GPs distinguish pneumonia from less serious infections, according to a large study published in the European Respiratory ...

New approach to tracking how deadly 'superbugs' travel could slow their spread

November 22, 2017
Killer bacteria - ones that have out-evolved our best antibiotics—may not go away anytime soon. But a new approach to tracking their spread could eventually give us a fighting chance to keep their death toll down.

Research points to diagnostic test for top cause of liver transplant in kids

November 22, 2017
Biliary atresia is the most common cause of liver transplants for children in the United States. Now researchers report in Science Translational Medicine finding a strong biomarker candidate that could be used for earlier ...

Metabolites altered in chronic kidney disease

November 22, 2017
Chronic kidney disease (CKD) affects 1 in 7 people in the United States, according to the U.S. National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK). These individuals have a very high risk of cardiovascular ...

Alcohol consumption and metabolic factors act together to increase the risk of severe liver disease

November 22, 2017
A new study provides insights into the interaction between alcohol consumption and metabolic factors in predicting severe liver disease in the general population. The findings, which are published in Hepatology, indicate ...

Rainfall can indicate that mosquito-borne epidemics will occur weeks later

November 22, 2017
A new study demonstrates that outbreaks of mosquito-borne viruses Zika and Chikungunya generally occur about three weeks after heavy rainfall.Researchers also found that Chikungunya will predominate over Zika when both circulate ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.