Osteoporosis: glucocorticoid-induced
Osteoporosis: glucocorticoid-induced
We know that one of the most important risk factors for osteoporosis is the use of corticosteroids. As these drugs are so widely used in clinical practice it is important we manage this risk appropriately.The most widely followed guidelines are based around the 2002 Royal College of Physicians (RCP) 'Glucocorticoid-induced osteoporosis: A concise guide to prevention and treatment'.
The risk of osteoporosis is thought to rise significantly once a patient is taking the equivalent of prednisolone 7.5mg a day for 3 or more months. It is important to note that we should manage patients in an anticipatory, i.e. if it likely that the patient will have to take steroids for at least 3 months then we should start bone protection straight away, rather than waiting until 3 months has elapsed. A good example is a patient with newly diagnosed polymyalgia rheumatica. As it is very likely they will be on a significant dose of prednisolone for greater than 3 months bone protection should be commenced immediately.
Management of patients at risk of corticosteroid-induced osteoporosis
The RCP guidelines essentially divide patients into two groups.
1. Patients over the age of 65 years or those who've previously had a fragility fracture should be offered bone protection.
2. Patients under the age of 65 years should be offered a bone density scan, with further management dependent:
| T score | Management |
|---|---|
| Greater than 0 | Reassure |
| Between 0 and -1.5 | Repeat bone density scan in 1-3 years |
| Less than -1.5 | Offer bone protection |
The first-line treatment is alendronate. Patients should also be calcium and vitamin D replete.
+PassMedicine Notes
We know that one of the most important risk factors for osteoporosis is the use of corticosteroids. As these drugs are so widely used in clinical practice it is important we manage this risk appropriately.
The most widely followed guidelines are based around the 2002 Royal College of Physicians (RCP) 'Glucocorticoid-induced osteoporosis: A concise guide to prevention and treatment'.
The risk of osteoporosis is thought to rise significantly once a patient is taking the equivalent of prednisolone 7.5mg a day for 3 or more months. It is important to note that we should manage patients in an anticipatory, i.e. if it likely that the patient will have to take steroids for at least 3 months then we should start bone protection straight away, rather than waiting until 3 months has elapsed. A good example is a patient with newly diagnosed polymyalgia rheumatica. As it is very likely they will be on a significant dose of prednisolone for greater than 3 months bone protection should be commenced immediately.
Management of patients at risk of corticosteroid-induced osteoporosis
The RCP guidelines essentially divide patients into two groups.
1. Patients over the age of 65 years or those who've previously had a fragility fracture should be offered bone protection.
2. Patients under the age of 65 years should be offered a bone density scan, with further management dependent:
T score _ Management | Greater than 0 _ Reassure| Between 0 and -1.5 _ Repeat bone density scan in 1-3 years| Less than -1.5 _ Offer bone protection|The first-line treatment is alendronate. Patients should also be calcium and vitamin D replete.
