Background: To develop guidelines and recommendations to prevent and treat glucocorticoid (GC)-induced osteoporosis (GIOP) in Korea.
Methods: The Korean Society for Bone and Mineral Research and the Korean College of Rheumatology have developed this guideline based on Guidance for the Development of Clinical Practice Guidelines ver. 1.0 established by the National Evidence-Based Healthcare Collaborating Agency. This guideline was developed by adapting previously published guidelines, and a systematic review and quality assessment were performed.
Results: This guideline applies to adults aged ≥19 years who are using or plan to use GCs. It does not include children and adolescents. An initial assessment of fracture risk should be performed within 6 months of initial GC use. Fracture risk should be estimated using the fracture-risk assessment tool (FRAX) after adjustments for GC dose, history of osteoporotic fractures, and bone mineral density (BMD) results. All patients administered with prednisolone or an equivalent medication at a dose ≥2.5 mg/day for ≥3 months are recommended to use adequate calcium and vitamin D during treatment. Patients showing a moderate-to-high fracture risk should be treated with additional medication for osteoporosis. All patients continuing GC therapy should undergo annual BMD testing, vertebral X-ray, and fracture risk assessment using FRAX. When treatment failure is suspected, switching to another drug should be considered.
Conclusions: This guideline is intended to guide clinicians in the prevention and treatment of GIOP.
Keywords: Bisphosphonate; Denosumab; Glucocorticoids; Osteporosis; Teriparatide.
Conflict of interest statement
CONFLICT OF INTEREST: Yoon-Kyung Sung has received financial support for clinical research sponsored by Pfizer within the last 2 years. Dong Ah Park has participated in the development of headache clinical practical guidelines for methodology consultation. The other authors declare no conflict of interest. If a committee member receives research funding from a company, that member does not participate in discussions or votes concerning that company's drug.
2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis.Arthritis Rheumatol. 2017 Aug;69(8):1521-1537. doi: 10.1002/art.40137. Epub 2017 Jun 6. Arthritis Rheumatol. 2017. PMID: 28585373 Review.
2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis.Arthritis Care Res (Hoboken). 2017 Aug;69(8):1095-1110. doi: 10.1002/acr.23279. Epub 2017 Jun 6. Arthritis Care Res (Hoboken). 2017. PMID: 28585410 Review.
Beyond bone mineral density, FRAX-based tailor-made intervention thresholds for therapeutic decision in subjects on glucocorticoid: A nationwide osteoporosis survey.Medicine (Baltimore). 2017 Feb;96(5):e5959. doi: 10.1097/MD.0000000000005959. Medicine (Baltimore). 2017. PMID: 28151883 Free PMC article. Clinical Trial.
Guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis.Rev Bras Reumatol. 2012 Aug;52(4):580-93. Rev Bras Reumatol. 2012. PMID: 22885424 English, Portuguese.
Prevalence and incidence of osteoporotic fractures in patients on long-term glucocorticoid treatment for rheumatic diseases: the Glucocorticoid Induced OsTeoporosis TOol (GIOTTO) study.Reumatismo. 2017 May 22;69(1):30-39. doi: 10.4081/reumatismo.2017.922. Reumatismo. 2017. PMID: 28535619 Clinical Trial.
Cited by 2 articles
Vitamin D supplementation does not prevent the recurrence of Graves' disease.Sci Rep. 2020 Jan 8;10(1):16. doi: 10.1038/s41598-019-55107-9. Sci Rep. 2020. PMID: 31913301 Free PMC article.
Treatment of Glucocorticoid-Induced Osteoporosis with Bisphosphonates Alone, Vitamin D Alone or a Combination Treatment in Eastern Asians: A Meta-Analysis.Curr Pharm Des. 2019;25(14):1653-1662. doi: 10.2174/1381612825666190619125426. Curr Pharm Des. 2019. PMID: 31218954 Free PMC article. Review.
- Saag KG, Koehnke R, Caldwell JR, et al. Low dose long-term corticosteroid therapy in rheumatoid arthritis: an analysis of serious adverse events. Am J Med. 1994;96:115–123. - PubMed
- Lane NE, Lukert B. The science and therapy of glucocorticoid-induced bone loss. Endocrinol Metab Clin North Am. 1998;27:465–483. - PubMed
- Van Staa TP, Laan RF, Barton IP, et al. Bone density threshold and other predictors of vertebral fracture in patients receiving oral glucocorticoid therapy. Arthritis Rheum. 2003;48:3224–3229. - PubMed
- Steinbuch M, Youket TE, Cohen S. Oral glucocorticoid use is associated with an increased risk of fracture. Osteoporos Int. 2004;15:323–328. - PubMed
- Angeli A, Guglielmi G, Dovio A, et al. High prevalence of asymptomatic vertebral fractures in post-menopausal women receiving chronic glucocorticoid therapy: a cross-sectional outpatient study. Bone. 2006;39:253–259. - PubMed