Osteoporosis International

, Volume 23, Issue 9, pp 2257–2276 | Cite as

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

  • S. Lekamwasam
  • J. D. Adachi
  • D. Agnusdei
  • J. Bilezikian
  • S. Boonen
  • F. Borgström
  • C. Cooper
  • A. Diez Perez
  • R. Eastell
  • L. C. Hofbauer
  • J. A. Kanis
  • B. L. Langdahl
  • O. Lesnyak
  • R. Lorenc
  • E. McCloskey
  • O. D. Messina
  • N. Napoli
  • B. Obermayer-Pietsch
  • S. H. Ralston
  • P. N. Sambrook
  • S. Silverman
  • M. Sosa
  • J. Stepan
  • G. Suppan
  • D. A. Wahl
  • J. E. CompstonEmail author
  • Joint IOF-ECTS GIO Guidelines Working Group
Position Paper



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 density Bone-protective therapy Fracture FRAX Glucocorticoids 



We are grateful to Amanda Sherwood and Heidi-Mai Warren from the European Calcified Tissue Society and Judy Stenmark from the International Osteoporosis Foundation, for administrative support. This paper has been consulted by the IOF Committee of National Societies and the following associations: EFFORT, AO Trauma, International Society of Orthopaedic Surgery and Traumatology, Endocrine Society, International Society of Endocrinology, AACE, ILAR, EULAR, ACR, International Menopause Society, International Association of Gerontology and Geriatrics, European Union Geriatric Medicine Society, American Geriatrics Society and ASBMR.

Conflict of interest

Adachi J.D. is consultant/speaker for Amgen, Eli Lilly, GSK, Merck, Novartis, Pfizer, Procter & Gamble, Roche, Sanofi Aventis and Warner Chilcott and received grants for clinical trials from Amgen, Bristol-Myers Squibb, Eli Lilly, Merck, Novartis, Pfizer, Procter & Gamble, Sanofi Aventis, Roche and Warner Chilcott.

Agnusdei D. is a stock holder and employee of Eli Lilly and Company.

Bilezikian J.P. receives consultancies and speaker fees for Amgen, Lilly, Merck and Novartis; consultancies for Radius Pharmaceuticals, NPS Pharmaceuticals and GSK; and research support from NPS Pharmaceuticals.

Boonen S. receives research support and/or consulting fees from Amgen, Merck, Novartis, Sanofi Aventis and Warner Chilcott.

Cooper C. receives lecture fees and consultancy from ABBH, Amgen, Eli Lilly, GSK/Roche, MSD, Novartis, Nycomed and Servier.

Diez Perez A. receives honoraria as consultant or speaker from Amgen, Eli Lilly and MSD as well as research funds from Alliance of Bone Health and Servier.

Eastell R. is a member of the Procter & Gamble National Advisory Board, Medical Research Council, European Calcified Tissue Society, Biobank MSK Advisory Board; a consultant for Amgen, AstraZeneca, GlaxoSmithKline, Medtronics, Nastech, Nestle, Fonterra Brands, Novartis, Ono Pharma, Osteologix, Pfizer, Eli Lilly, Sanofi Aventis, Tethys, Unilever, Unipath, Inverness Medical, Johnson & Johnson, SPD and MSD and IDS; received grants from AstraZeneca, Unilever, Amgen, Department of Health, National Institute for Health Research, Sheffield Teaching Hospitals Trust, Queen Mary University of London, Procter & Gamble, Unipath Limited, Novartis, Medical Research Council UK, Arthritis Research UK, Nestle Foundation and Sanofi Aventis; received payment for lectures including service on speakers bureaus from Takeda, Eli Lilly, Amgen, National Osteoporosis Foundation, Procter & Gamble, GlaxoSmithKline Nutrition and Roche; received travel, accommodations or meeting expenses from Novartis, Procter & Gamble, GlaxoSmithKline Nutrition, Fonterra Brands, Amgen, AstraZeneca, Medtronics, Unilever, Ono Pharma, Servier, Tethys, Eli Lilly, SPD and International Osteoporosis Foundation.

Kanis J.A. receives consulting fees, paid advisory boards, lecture fees and/or grant support from the majority of companies concerned with skeletal metabolism.

Langdahl B. is a member of the advisory board of Amgen, Lilly, Nycomed and MSD and the speakers bureau of Lilly, Amgen and MSD; and received research funding from Lilly, Novartis, MSD and Amgen.

McCloskey E. receives research funding and/or advisory board and/or speaker's fees from the following: Amgen, AstraZeneca, GSK, Hologic, Innovus, Lilly, MSD, Novartis, Pfizer, Roche, Servier, Tethys and Warner Chilcott.

Napoli N. receives consultancy and lecture fees from MSD.

Ralston S. received research grants from Amgen and his employer received consultancy income from Amgen, Merck and Novartis.

Silverman S. is a member of the speaker's bureau for Amgen, Lilly, Pfizer and Roche Pharmaceuticals; a consultant for Amgen, Lilly, Novartis, Pfizer, Roche Pharmaceuticals, Roche Diagnostics and Warner Chilcott; and received research support from Alliance for Better Bone Health, Lilly and Pfizer.

Compston J.E. receives consultancy fees and lecture fees, and/or received grant support from the Alliance for Better Bone Health, Amgen, Eli Lilly, GlaxoSmithKline, Medtronic, MSD, Novartis, Nycomed, Procter & Gamble, Sanofi Aventis, Servier and Warner Chilcott.

Borgstrom F., Hofbauer L., Lekamwasam S., Lesnyak O., Lorenc R., Messina O.D., Obermayer-Pietsch B., Stepan J., Sambrook P., Sosa M., Suppan G. and Wahl D.A. declare no conflict of interest.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  • S. Lekamwasam
    • 1
  • J. D. Adachi
    • 2
  • D. Agnusdei
    • 3
  • J. Bilezikian
    • 4
  • S. Boonen
    • 5
  • F. Borgström
    • 6
  • C. Cooper
    • 7
  • A. Diez Perez
    • 8
  • R. Eastell
    • 9
  • L. C. Hofbauer
    • 10
  • J. A. Kanis
    • 11
  • B. L. Langdahl
    • 12
  • O. Lesnyak
    • 13
  • R. Lorenc
    • 14
  • E. McCloskey
    • 9
  • O. D. Messina
    • 15
  • N. Napoli
    • 16
  • B. Obermayer-Pietsch
    • 17
  • S. H. Ralston
    • 18
  • P. N. Sambrook
    • 19
  • S. Silverman
    • 20
  • M. Sosa
    • 21
  • J. Stepan
    • 22
    • 23
  • G. Suppan
    • 24
  • D. A. Wahl
    • 26
  • J. E. Compston
    • 25
    Email author
  • Joint IOF-ECTS GIO Guidelines Working Group
  1. 1.Department of Medicine, Faculty of MedicineCentre for Metabolic Bone DiseasesGalleSri Lanka
  2. 2.Division of Rheumatology, Department of MedicineMcMaster UniversityHamiltonCanada
  3. 3.Eli Lilly and Co.FlorenceItaly
  4. 4.College of Physicians and SurgeonsColumbia UniversityNew YorkUSA
  5. 5.Division of Gerontology and Geriatrics and Center for Musculoskeletal Research, Department of Experimental MedicineLeuven UniversityLeuvenBelgium
  6. 6.Quantify Research and LIME/MMCKarolinska InstitutetStockholmSweden
  7. 7.MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton and NIHR Musculoskeletal Biomedical Research Unit, Institute of Musculoskeletal SciencesUniversity of OxfordOxfordUK
  8. 8.Hospital del Mar-IMIM-Universitat AutónomaBarcelonaSpain
  9. 9.Academic Unit of Bone Metabolism, University of Sheffield and NIHR Musculoskeletal Biomedical Research UnitSheffield Teaching Hospitals NHS TrustSheffieldUK
  10. 10.Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine IIIDresden Technical University Medical CenterDresdenGermany
  11. 11.Centre for Metabolic Bone Diseases (WHO Collaborating Centre)University of Sheffield Medical SchoolSheffieldUK
  12. 12.Department of EndocrinologyAarhus University HospitalAarhusDenmark
  13. 13.Russian Association on OsteoporosisYekaterinburgRussia
  14. 14.Department of Biochemistry and Experimental MedicineThe Children’s Memorial Health InstituteWarsawPoland
  15. 15.Department of RheumatologyC. Argerich HospitalBuenos AiresArgentina
  16. 16.Division of EndocrinologyCampus Bio-Medico UniversityRomeItaly
  17. 17.Division of Endocrinology and Metabolism, Department of Internal MedicineMedical University of GrazGrazAustria
  18. 18.Rheumatic Diseases Unit, Molecular Medicine Centre, Institute of Genetics and Molecular Medicine, Western General HospitalUniversity of EdinburghEdinburghUK
  19. 19.University of Sydney-Royal North Shore HospitalSt LeonardsAustralia
  20. 20.Cedars-Sinai/University of CaliforniaLos AngelesUSA
  21. 21.Investigation Group on Osteoporosis, Hospital University Insular, Bone Metabolic UnitUniversity of Las Palmas de Gran CanariaLas Palmas de Gran CanariaSpain
  22. 22.Institute of RheumatologyPragueCzech Republic
  23. 23.Faculty of Medicine 1Charles UniversityPragueCzech Republic
  24. 24.Action for Healthy BonesGrazAustria
  25. 25.International Osteoporosis FoundationNyonSwitzerland
  26. 26.Department of MedicineCambridge University Hospitals NHS Foundation TrustCambridgeUK

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