Osteoporosis International

, Volume 23, Issue 9, pp 2257–2276

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


  • S. Lekamwasam
    • Department of Medicine, Faculty of MedicineCentre for Metabolic Bone Diseases
  • J. D. Adachi
    • Division of Rheumatology, Department of MedicineMcMaster University
  • D. Agnusdei
    • Eli Lilly and Co.
  • J. Bilezikian
    • College of Physicians and SurgeonsColumbia University
  • S. Boonen
    • Division of Gerontology and Geriatrics and Center for Musculoskeletal Research, Department of Experimental MedicineLeuven University
  • F. Borgström
    • Quantify Research and LIME/MMCKarolinska Institutet
  • C. Cooper
    • MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton and NIHR Musculoskeletal Biomedical Research Unit, Institute of Musculoskeletal SciencesUniversity of Oxford
  • A. Diez Perez
    • Hospital del Mar-IMIM-Universitat Autónoma
  • R. Eastell
    • Academic Unit of Bone Metabolism, University of Sheffield and NIHR Musculoskeletal Biomedical Research UnitSheffield Teaching Hospitals NHS Trust
  • L. C. Hofbauer
    • Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine IIIDresden Technical University Medical Center
  • J. A. Kanis
    • Centre for Metabolic Bone Diseases (WHO Collaborating Centre)University of Sheffield Medical School
  • B. L. Langdahl
    • Department of EndocrinologyAarhus University Hospital
  • O. Lesnyak
    • Russian Association on Osteoporosis
  • R. Lorenc
    • Department of Biochemistry and Experimental MedicineThe Children’s Memorial Health Institute
  • E. McCloskey
    • Academic Unit of Bone Metabolism, University of Sheffield and NIHR Musculoskeletal Biomedical Research UnitSheffield Teaching Hospitals NHS Trust
  • O. D. Messina
    • Department of RheumatologyC. Argerich Hospital
  • N. Napoli
    • Division of EndocrinologyCampus Bio-Medico University
  • B. Obermayer-Pietsch
    • Division of Endocrinology and Metabolism, Department of Internal MedicineMedical University of Graz
  • S. H. Ralston
    • Rheumatic Diseases Unit, Molecular Medicine Centre, Institute of Genetics and Molecular Medicine, Western General HospitalUniversity of Edinburgh
  • P. N. Sambrook
    • University of Sydney-Royal North Shore Hospital
  • S. Silverman
    • Cedars-Sinai/University of California
  • M. Sosa
    • Investigation Group on Osteoporosis, Hospital University Insular, Bone Metabolic UnitUniversity of Las Palmas de Gran Canaria
  • J. Stepan
    • Institute of Rheumatology
    • Faculty of Medicine 1Charles University
  • G. Suppan
    • Action for Healthy Bones
  • D. A. Wahl
    • Department of MedicineCambridge University Hospitals NHS Foundation Trust
    • International Osteoporosis Foundation
  • Joint IOF-ECTS GIO Guidelines Working Group
Position Paper

DOI: 10.1007/s00198-012-1958-1

Cite this article as:
Lekamwasam, S., Adachi, J.D., Agnusdei, D. et al. Osteoporos Int (2012) 23: 2257. doi:10.1007/s00198-012-1958-1



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.


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.


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.


Bone mineral densityBone-protective therapyFractureFRAXGlucocorticoids

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012