Position Paper

Osteoporosis International

, Volume 23, Issue 9, pp 2257-2276

A framework for the development of guidelines for the management of glucocorticoid-induced osteoporosis

  • S. LekamwasamAffiliated withDepartment of Medicine, Faculty of Medicine, Centre for Metabolic Bone Diseases
  • , J. D. AdachiAffiliated withDivision of Rheumatology, Department of Medicine, McMaster University
  • , D. AgnusdeiAffiliated withEli Lilly and Co.
  • , J. BilezikianAffiliated withCollege of Physicians and Surgeons, Columbia University
  • , S. BoonenAffiliated withDivision of Gerontology and Geriatrics and Center for Musculoskeletal Research, Department of Experimental Medicine, Leuven University
  • , F. BorgströmAffiliated withQuantify Research and LIME/MMC, Karolinska Institutet
  • , C. CooperAffiliated withMRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton and NIHR Musculoskeletal Biomedical Research Unit, Institute of Musculoskeletal Sciences, University of Oxford
  • , A. Diez PerezAffiliated withHospital del Mar-IMIM-Universitat Autónoma
  • , R. EastellAffiliated withAcademic Unit of Bone Metabolism, University of Sheffield and NIHR Musculoskeletal Biomedical Research Unit, Sheffield Teaching Hospitals NHS Trust
    • , L. C. HofbauerAffiliated withDepartment of Medicine, Faculty of Medicine, Centre for Metabolic Bone DiseasesDivision of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine III, Dresden Technical University Medical Center
    • , J. A. KanisAffiliated withDepartment of Medicine, Faculty of Medicine, Centre for Metabolic Bone DiseasesCentre for Metabolic Bone Diseases (WHO Collaborating Centre), University of Sheffield Medical School
    • , B. L. LangdahlAffiliated withDepartment of Medicine, Faculty of Medicine, Centre for Metabolic Bone DiseasesDepartment of Endocrinology, Aarhus University Hospital
    • , O. LesnyakAffiliated withDepartment of Medicine, Faculty of Medicine, Centre for Metabolic Bone DiseasesRussian Association on Osteoporosis
    • , R. LorencAffiliated withDepartment of Medicine, Faculty of Medicine, Centre for Metabolic Bone DiseasesDepartment of Biochemistry and Experimental Medicine, The Children’s Memorial Health Institute
    • , E. McCloskeyAffiliated withAcademic Unit of Bone Metabolism, University of Sheffield and NIHR Musculoskeletal Biomedical Research Unit, Sheffield Teaching Hospitals NHS Trust
    • , O. D. MessinaAffiliated withDepartment of Medicine, Faculty of Medicine, Centre for Metabolic Bone DiseasesDepartment of Rheumatology, C. Argerich Hospital
    • , N. NapoliAffiliated withDepartment of Medicine, Faculty of Medicine, Centre for Metabolic Bone DiseasesDivision of Endocrinology, Campus Bio-Medico University
    • , B. Obermayer-PietschAffiliated withDepartment of Medicine, Faculty of Medicine, Centre for Metabolic Bone DiseasesDivision of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz
    • , S. H. RalstonAffiliated withDepartment of Medicine, Faculty of Medicine, Centre for Metabolic Bone DiseasesRheumatic Diseases Unit, Molecular Medicine Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh
    • , P. N. SambrookAffiliated withDepartment of Medicine, Faculty of Medicine, Centre for Metabolic Bone DiseasesUniversity of Sydney-Royal North Shore Hospital
    • , S. SilvermanAffiliated withDivision of Rheumatology, Department of Medicine, McMaster UniversityCedars-Sinai/University of California
    • , M. SosaAffiliated withDivision of Rheumatology, Department of Medicine, McMaster UniversityInvestigation Group on Osteoporosis, Hospital University Insular, Bone Metabolic Unit, University of Las Palmas de Gran Canaria
    • , J. StepanAffiliated withDivision of Rheumatology, Department of Medicine, McMaster UniversityInstitute of RheumatologyFaculty of Medicine 1, Charles University
    • , G. SuppanAffiliated withDivision of Rheumatology, Department of Medicine, McMaster UniversityAction for Healthy Bones
    • , D. A. WahlAffiliated withDivision of Rheumatology, Department of Medicine, McMaster UniversityDepartment of Medicine, Cambridge University Hospitals NHS Foundation Trust
    • , J. E. CompstonAffiliated withDivision of Rheumatology, Department of Medicine, McMaster UniversityInternational Osteoporosis Foundation Email author 
    • , Joint IOF-ECTS GIO Guidelines Working Group

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Abstract

Summary

This paper provides a framework for the development of national guidelines for the management of glucocorticoid-induced osteoporosis in men and women aged 18 years and over in whom oral glucocorticoid therapy is considered for 3 months or longer.

Introduction

The need for updated guidelines for Europe and other parts of the world was recognised by the International Osteoporosis Foundation and the European Calcified Tissue Society, which set up a joint Guideline Working Group at the end of 2010.

Methods and results

The epidemiology of GIO is reviewed. Assessment of risk used a fracture probability-based approach, and intervention thresholds were based on 10-year probabilities using FRAX. The efficacy of intervention was assessed by a systematic review.

Conclusions

Guidance for glucocorticoid-induced osteoporosis is updated in the light of new treatments and methods of assessment. National guidelines derived from this resource need to be tailored within the national healthcare framework of each country.

Keywords

Bone mineral density Bone-protective therapy Fracture FRAX Glucocorticoids