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German Society of Rheumatology recommendations for management of glucocorticoid-induced osteoporosis

Empfehlungen der Deutschen Gesellschaft für Rheumatologie für die Behandlung der glukokortikoidinduzierten Osteoporose. Englische Version

Abstract

Background

Glucocorticoids are of substantial therapeutic importance in the treatment of inflammatory diseases, but are also associated with bone mineral density loss, osteoporosis, and fractures, especially with long-term use.

Objective

To develop recommendations for the management of glucocorticoid-induced osteoporosis (GIOP) in adult patients on long-term glucocorticoid (GC) treatment.

Methods

A systematic literature search (SLR) was conducted to synthesize the evidence for GIOP prevention and treatment options. Recommendations were developed based on SLR/level of evidence and by previously defined questions and in a structured group consensus process.

Results

Recommendations include supplementation with calcium and vitamin D under long-term GC therapy in adults. If specific osteologic treatment is indicated, we recommend bisphosphonates or denosumab as first-line treatment. If fracture risk is high, we recommend teriparatide as primary specific osteologic treatment. Denosumab should be used in cases of severe renal insufficiency, and specific osteologic treatment should not be given in pregnancy. For patients who have not reached the treatment goal, a switch to another class of specific osteologic drugs should be performed. We recommend re-evaluation after a treatment duration of 3–5 years or after termination of long-term GC treatment.

Conclusion

This work aims to provide evidence-based and consensus-based recommendations for the best possible management of GIOP in Germany and to support treatment decisions.

Zusammenfassung

Hintergrund

Glukokortikoide sind von erheblicher therapeutischer Bedeutung bei der Behandlung entzündlicher Erkrankungen, jedoch insbesondere bei langfristiger Anwendung mit Knochenmineraldichteverlust, Osteoporose und Frakturen assoziiert.

Ziel dieser Arbeit

Es sollten Empfehlungen zum Management der Glukokortikoid-induzierten Osteoporose (GIOP) bei erwachsenen Patienten unter Langzeit-Glukokortikoid(GC)-Therapie entwickelt werden.

Methodik

Es wurde eine systematische Literatursuche (SLR) durchgeführt, um die Evidenz für Präventions- und Behandlungsoptionen der GIOP zusammenzufassen. Mithilfe zuvor definierter Fragestellungen wurden, basierend auf SLR und dem Evidenzgrad, Empfehlungen in einem strukturierten Gruppenkonsensprozess erarbeitet.

Ergebnisse

Die Empfehlungen umfassen zunächst die Supplementation mit Kalzium und Vitamin D bei Erwachsenen unter Langzeit-GC-Therapie. Wenn eine spezifische osteologische Therapie angezeigt ist, empfehlen wir als Erstlinientherapie Bisphosphonate oder Denosumab. Bei hohem Frakturrisiko empfehlen wir Teriparatid als primäre spezifische osteologische Therapie. Bei hochgradiger Niereninsuffizienz soll Denosumab (nach Ausschluss renaler Osteopathie) eingesetzt werden und bei Schwangerschaft keine spezifische osteologische Therapie erfolgen. Für Patienten, die das Therapieziel nicht erreicht haben, sollte die Umstellung auf eine andere Klasse spezifischer osteologischer Medikamente erfolgen. Wir empfehlen eine Reevaluation nach einer Therapiedauer von 3 bis 5 Jahren oder nach Beendigung der Langzeit-GC-Therapie.

Fazit

Diese Arbeit soll evidenz- und konsensbasierte Empfehlungen für ein bestmögliches Management der GIOP in Deutschland geben und bei Behandlungsentscheidungen unterstützen.

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Notes

  1. 1.

    Standard deviation and confidence intervals are available in the evidence tables in the supplement for better readability of the manuscript text.

Abbreviations

ACR:

American College of Rheumatology

BMD:

Bone mineral density

DVO:

Dachverband Osteologie

DXA:

Dual-energy X‑ray absorptiometry

FRAX:

Fracture Risk Assessment Tool

GC:

Glucocorticoids

GFR:

Glomerular filtration rate

GIOP:

Glucocorticoid-induced osteoporosis

NNT:

Number needed to treat

RANKL:

Receptor activator of NF-κB ligand

RCT:

Randomized controlled trial

SD:

Standard deviation

SLR:

Systematic literature review

References

  1. 1.

    AWMF online (2017) Prophylaxe, Diagnostik und Therapie der Osteoporose. https://www.awmf.org/uploads/tx_szleitlinien/183-001l_S3_Osteoporose-Prophylaxe-Diagnostik-Therapie_2019-02.pdf. Zugegriffen: 01.07.2021

  2. 2.

    Adachi JD, Bensen WG, Bianchi F et al (1996) Vitamin D and calcium in the prevention of corticosteroid induced osteoporosis: a 3 year followup. J Rheumatol 23:995–1000

    CAS  PubMed  Google Scholar 

  3. 3.

    Adachi JD, Saag KG, Delmas PD et al (2001) Two-year effects of alendronate on bone mineral density and vertebral fracture in patients receiving glucocorticoids: a randomized, double-blind, placebo-controlled extension trial. Arthritis Rheum 44:202–211

    CAS  PubMed  Article  Google Scholar 

  4. 4.

    Adami G, Rahn EJ, Saag KG (2019) Glucocorticoid-induced osteoporosis: from clinical trials to clinical practice. Ther Adv Musculoskelet Dis 11:1759720X19876468

    PubMed  PubMed Central  Google Scholar 

  5. 5.

    Adami G, Saag KG (2019) Glucocorticoid-induced osteoporosis: 2019 concise clinical review. Osteoporos Int 30:1145–1156

    CAS  PubMed  Article  Google Scholar 

  6. 6.

    Adams AL, Adams JL, Raebel MA et al (2018) Bisphosphonate drug holiday and fracture risk: a population-based cohort study. J Bone Miner Res 33:1252–1259

    CAS  PubMed  Article  Google Scholar 

  7. 7.

    Albaum JM, Levesque LE, Gershon AS et al (2015) Glucocorticoid-induced osteoporosis management among seniors, by year, sex, and indication, 1996–2012. Osteoporos Int 26:2845–2852

    CAS  PubMed  Article  Google Scholar 

  8. 8.

    Allen CS, Yeung JH, Vandermeer B et al (2016) Bisphosphonates for steroid-induced osteoporosis. Cochrane Database Syst Rev 10:CD1347

    PubMed  Google Scholar 

  9. 9.

    Amiche MA, Abtahi S, Driessen JHM et al (2018) Impact of cumulative exposure to high-dose oral glucocorticoids on fracture risk in Denmark: a population-based case-control study. Arch Osteoporos 13:30

    PubMed  PubMed Central  Article  Google Scholar 

  10. 10.

    Amiche MA, Albaum JM, Tadrous M et al (2016) Fracture risk in oral glucocorticoid users: a Bayesian meta-regression leveraging control arms of osteoporosis clinical trials. Osteoporos Int 27:1709–1718

    CAS  PubMed  Article  Google Scholar 

  11. 11.

    Andrews EB, Gilsenan AW, Midkiff K et al (2012) The US postmarketing surveillance study of adult osteosarcoma and teriparatide: study design and findings from the first 7 years. J Bone Miner Res 27:2429–2437

    CAS  PubMed  Article  Google Scholar 

  12. 12.

    Angeli A, Guglielmi G, Dovio A et al (2006) High prevalence of asymptomatic vertebral fractures in post-menopausal women receiving chronic glucocorticoid therapy: a cross-sectional outpatient study. Bone 39:253–259

    CAS  PubMed  Article  Google Scholar 

  13. 13.

    Anonymous (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO study group. World Health Organ Tech Rep Ser 843:1–129

    Google Scholar 

  14. 14.

    AWMF (2018) Antiresorptiva-assoziierte Kiefernekrosen. https://www.awmf.org/uploads/tx_szleitlinien/007-091l_S3_Antiresorptiva-assoziierte-Kiefernekrosen-AR-ONJ_2018-12.pdf. Zugegriffen: 01.07.2021

  15. 15.

    Balasubramanian A, Wade SW, Adler RA et al (2016) Glucocorticoid exposure and fracture risk in patients with new-onset rheumatoid arthritis. Osteoporos Int 27:3239–3249

    CAS  PubMed  Article  Google Scholar 

  16. 16.

    Bolland MJ, Avenell A, Baron JA et al (2010) Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 341:c3691

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  17. 17.

    Bolland MJ, Grey A, Avenell A et al (2011) Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the women’s health initiative limited access dataset and meta-analysis. BMJ 342:d2040

    PubMed  PubMed Central  Article  Google Scholar 

  18. 18.

    Braun JJ, Birkenhager-Frenkel DH, Rietveld AH et al (1983) Influence of 1 alpha-(OH)D3 administration on bone and bone mineral metabolism in patients on chronic glucocorticoid treatment; a double blind controlled study. Clin Endocrinol (Oxf) 19:265–273

    CAS  Article  Google Scholar 

  19. 19.

    Buckley L, Guyatt G, Fink HA et al (2017) 2017 American college of rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res (Hoboken) 69:1095–1110

    Article  Google Scholar 

  20. 20.

    Buckley L, Guyatt G, Fink HA et al (2017) 2017 American college of rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheumatol 69:1521–1537

    Article  Google Scholar 

  21. 21.

    Canalis E, Mazziotti G, Giustina A et al (2007) Glucocorticoid-induced osteoporosis: pathophysiology and therapy. Osteoporos Int 18:1319–1328

    CAS  PubMed  Article  Google Scholar 

  22. 22.

    Caplan A, Fett N, Rosenbach M et al (2017) Prevention and management of glucocorticoid-induced side effects: a comprehensive review: a review of glucocorticoid pharmacology and bone health. J Am Acad Dermatol 76:1–9

    PubMed  Article  Google Scholar 

  23. 23.

    Chen Y, Wan JX, Jiang DW et al (2015) Efficacy of calcitriol in treating glucocorticoidinduced osteoporosis in patients with nephrotic syndrome: an open-label, randomized controlled study. Clin Nephrol 84:262–269

    CAS  PubMed  Article  Google Scholar 

  24. 24.

    Coco M, Pullman J, Cohen HW et al (2012) Effect of risedronate on bone in renal transplant recipients. J Am Soc Nephrol 23:1426–1437

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  25. 25.

    Cohen S, Levy RM, Keller M et al (1999) Risedronate therapy prevents corticosteroid-induced bone loss: a twelve-month, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Arthritis Rheum 42:2309–2318

    CAS  PubMed  Article  Google Scholar 

  26. 26.

    Compston J, Cooper A, Cooper C et al (2017) UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos 12:43

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  27. 27.

    Crawford BA, Kam C, Pavlovic J et al (2006) Zoledronic acid prevents bone loss after liver transplantation: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 144:239–248

    CAS  PubMed  Article  Google Scholar 

  28. 28.

    Cummings SR, Ferrari S, Eastell R et al (2018) Vertebral fractures after discontinuation of denosumab: a post hoc analysis of the randomized placebo-controlled FREEDOM trial and its extension. J Bone Miner Res 33:190–198

    CAS  PubMed  Article  Google Scholar 

  29. 29.

    De Vries F, Bracke M, Leufkens HG et al (2007) Fracture risk with intermittent high-dose oral glucocorticoid therapy. Arthritis Rheum 56:208–214

    CAS  PubMed  Article  Google Scholar 

  30. 30.

    Dore RK, Cohen SB, Lane NE et al (2010) Effects of denosumab on bone mineral density and bone turnover in patients with rheumatoid arthritis receiving concurrent glucocorticoids or bisphosphonates. Ann Rheum Dis 69:872–875

    CAS  PubMed  Article  Google Scholar 

  31. 31.

    Eastell R, Rosen CJ, Black DM et al (2019) Pharmacological management of osteoporosis in postmenopausal women: an endocrine society* clinical practice guideline. J Clin Endocrinol Metab 104:1595–1622

    PubMed  Article  Google Scholar 

  32. 32.

    European Prospective Osteoporosis Study G, Felsenberg D, Silman AJ et al (2002) Incidence of vertebral fracture in europe: results from the European prospective osteoporosis study (EPOS). J Bone Miner Res 17:716–724

    Article  Google Scholar 

  33. 33.

    Feldstein AC, Elmer PJ, Nichols GA et al (2005) Practice patterns in patients at risk for glucocorticoid-induced osteoporosis. Osteoporos Int 16:2168–2174

    CAS  PubMed  Article  Google Scholar 

  34. 34.

    Fink HA, Macdonald R, Forte ML et al (2019) Long-term drug therapy and drug discontinuations and holidays for osteoporosis fracture prevention: a systematic review. Ann Intern Med 171:37–50

    PubMed  Article  Google Scholar 

  35. 35.

    Gluer CC, Marin F, Ringe JD et al (2013) Comparative effects of teriparatide and risedronate in glucocorticoid-induced osteoporosis in men: 18-month results of the EuroGIOPs trial. J Bone Miner Res 28:1355–1368

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Gu C, Zhao R, Zhang X et al (2019) A meta-analysis of secondary osteoporosis in systemic lupus erythematosus: prevalence and risk factors. Arch Osteoporos 15:1

    PubMed  Article  PubMed Central  Google Scholar 

  37. 37.

    Guadalix S, Martinez-Diaz-Guerra G, Lora D et al (2011) Effect of early risedronate treatment on bone mineral density and bone turnover markers after liver transplantation: a prospective single-center study. Transpl Int 24:657–665

    CAS  PubMed  Article  Google Scholar 

  38. 38.

    Hakala M, Kroger H, Valleala H et al (2012) Once-monthly oral ibandronate provides significant improvement in bone mineral density in postmenopausal women treated with glucocorticoids for inflammatory rheumatic diseases: a 12-month, randomized, double-blind, placebo-controlled trial. Scand J Rheumatol 41:260–266

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  39. 39.

    Hall GM, Spector TD, Griffin AJ et al (1993) The effect of rheumatoid arthritis and steroid therapy on bone density in postmenopausal women. Arthritis Rheum 36:1510–1516

    CAS  PubMed  Article  Google Scholar 

  40. 40.

    Hsia J, Heiss G, Ren H et al (2007) Calcium/vitamin D supplementation and cardiovascular events. Circulation 115:846–854

    CAS  PubMed  Article  Google Scholar 

  41. 41.

    Icks A, Haastert B, Wildner M et al (2008) Trend of hip fracture incidence in Germany 1995–2004: a population-based study. Osteoporos Int 19:1139–1145

    CAS  PubMed  Article  Google Scholar 

  42. 42.

    Iseri K, Iyoda M, Watanabe M et al (2018) The effects of denosumab and alendronate on glucocorticoid-induced osteoporosis in patients with glomerular disease: a randomized, controlled trial. PLoS ONE 13:e193846

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  43. 43.

    Jackson RD, Lacroix AZ, Gass M et al (2006) Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med 354:669–683

    CAS  PubMed  Article  Google Scholar 

  44. 44.

    Kanis JA, Johansson H, Oden A et al (2011) Guidance for the adjustment of FRAX according to the dose of glucocorticoids. Osteoporos Int 22:809–816

    CAS  PubMed  Article  Google Scholar 

  45. 45.

    Karras D, Stoykov I, Lems WF et al (2012) Effectiveness of teriparatide in postmenopausal women with osteoporosis and glucocorticoid use: 3‑year results from the EFOS study. J Rheumatol 39:600–609

    CAS  PubMed  Article  Google Scholar 

  46. 46.

    Khan B, Nowson CA, Daly RM et al (2015) Higher dietary calcium intakes are associated with reduced risks of fractures, cardiovascular events, and mortality: a prospective cohort study of older men and women. J Bone Miner Res 30:1758–1766

    CAS  PubMed  Article  Google Scholar 

  47. 47.

    Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group (2011) KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl 7:1–59

    Google Scholar 

  48. 48.

    Laan RF, van Riel PL, van de Putte LB et al (1993) Low-dose prednisone induces rapid reversible axial bone loss in patients with rheumatoid arthritis. A randomized, controlled study. Ann Intern Med 119:963–968

    CAS  PubMed  Article  Google Scholar 

  49. 49.

    Lane NE, Sanchez S, Modin GW et al (1998) Parathyroid hormone treatment can reverse corticosteroid-induced osteoporosis. Results of a randomized controlled clinical trial. J Clin Invest 102:1627–1633

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  50. 50.

    Langdahl BL, Silverman S, Fujiwara S et al (2018) Real-world effectiveness of teriparatide on fracture reduction in patients with osteoporosis and comorbidities or risk factors for fractures: Integrated analysis of 4 prospective observational studies. Bone 116:58–66

    CAS  PubMed  Article  Google Scholar 

  51. 51.

    Lekamwasam S, Adachi JD, Agnusdei D et al (2012) A framework for the development of guidelines for the management of glucocorticoid-induced osteoporosis. Osteoporos Int 23:2257–2276

    CAS  PubMed  Article  Google Scholar 

  52. 52.

    Lekamwasam S, Adachi JD, Agnusdei D et al (2012) An appendix to the 2012 IOF-ECTS guidelines for the management of glucocorticoid-induced osteoporosis. Arch Osteoporos 7:25–30

    CAS  PubMed  Article  Google Scholar 

  53. 53.

    Lems WF, Lodder MC, Lips P et al (2006) Positive effect of alendronate on bone mineral density and markers of bone turnover in patients with rheumatoid arthritis on chronic treatment with low-dose prednisone: a randomized, double-blind, placebo-controlled trial. Osteoporos Int 17:716–723

    CAS  PubMed  Article  Google Scholar 

  54. 54.

    Leslie WD, Adler RA, El-Hajj Fuleihan G et al (2006) Application of the 1994 WHO classification to populations other than postmenopausal Caucasian women: the 2005 ISCD official positions. J Clin Densitom 9:22–30

    PubMed  Article  Google Scholar 

  55. 55.

    Li K, Kaaks R, Linseisen J et al (2012) Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European prospective investigation into cancer and nutrition study (EPIC-Heidelberg). Heart 98:920–925

    CAS  PubMed  Article  Google Scholar 

  56. 56.

    Locascio V, Bonucci E, Imbimbo B et al (1990) Bone loss in response to long-term glucocorticoid therapy. Bone Miner 8:39–51

    CAS  PubMed  Article  Google Scholar 

  57. 57.

    Majumdar SR, Lix LM, Morin SN et al (2013) The disconnect between better quality of glucocorticoid-induced osteoporosis preventive care and better outcomes: a population-based cohort study. J Rheumatol 40:1736–1741

    CAS  PubMed  Article  Google Scholar 

  58. 58.

    Majumdar SR, Lix LM, Yogendran M et al (2012) Population-based trends in osteoporosis management after new initiations of long-term systemic glucocorticoids (1998–2008). J Clin Endocrinol Metab 97:1236–1242

    CAS  PubMed  Article  Google Scholar 

  59. 59.

    Mcdonough AK, Curtis JR, Saag KG (2008) The epidemiology of glucocorticoid-associated adverse events. Curr Opin Rheumatol 20:131–137

    PubMed  Article  Google Scholar 

  60. 60.

    Michos ED, Blumenthal RS (2007) Vitamin D supplementation and cardiovascular disease risk. Circulation 115:827–828

    PubMed  Article  Google Scholar 

  61. 61.

    Mok CC, Ho LY, Ma KM (2015) Switching of oral bisphosphonates to denosumab in chronic glucocorticoid users: a 12-month randomized controlled trial. Bone 75:222–228

    CAS  PubMed  Article  Google Scholar 

  62. 62.

    Okada Y, Nawata M, Nakayamada S et al (2008) Alendronate protects premenopausal women from bone loss and fracture associated with high-dose glucocorticoid therapy. J Rheumatol 35:2249–2254

    CAS  PubMed  Article  Google Scholar 

  63. 63.

    Park SY, Gong HS, Kim KM et al (2018) Korean guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. J Bone Metab 25:195–211

    PubMed  PubMed Central  Article  Google Scholar 

  64. 64.

    Raterman HG, Bultink IE, Lems WF (2020) Osteoporosis in patients with rheumatoid arthritis: an update in epidemiology, pathogenesis, and fracture prevention. Expert Opin Pharmacother 21:1725–1737

    PubMed  Article  Google Scholar 

  65. 65.

    Reid DM, Devogelaer JP, Saag K et al (2009) Zoledronic acid and risedronate in the prevention and treatment of glucocorticoid-induced osteoporosis (HORIZON): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet 373:1253–1263

    CAS  PubMed  Article  Google Scholar 

  66. 66.

    Reid DM, Hughes RA, Laan RF et al (2000) Efficacy and safety of daily risedronate in the treatment of corticosteroid-induced osteoporosis in men and women: a randomized trial. European corticosteroid-induced osteoporosis treatment study. J Bone Miner Res 15:1006–1013

    CAS  PubMed  Article  Google Scholar 

  67. 67.

    Roux C, Briot K (2017) Imminent fracture risk. Osteoporos Int 28:1765–1769

    CAS  PubMed  Article  Google Scholar 

  68. 68.

    Saag KG, Agnusdei D, Hans D et al (2016) Trabecular bone score in patients with chronic glucocorticoid therapy-induced osteoporosis treated with alendronate or teriparatide. Arthritis Rheumatol 68:2122–2128

    CAS  PubMed  Article  Google Scholar 

  69. 69.

    Saag KG, Emkey R, Schnitzer TJ et al (1998) Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis. Glucocorticoid-induced osteoporosis intervention study group. N Engl J Med 339:292–299

    CAS  PubMed  Article  Google Scholar 

  70. 70.

    Saag KG, Koehnke R, Caldwell JR et al (1994) Low dose long-term corticosteroid therapy in rheumatoid arthritis: an analysis of serious adverse events. Am J Med 96:115–123

    CAS  PubMed  Article  Google Scholar 

  71. 71.

    Saag KG, Pannacciulli N, Geusens P et al (2019) Denosumab versus risedronate in glucocorticoid-induced osteoporosis: final results of a twenty-four-month randomized, double-blind, double-dummy trial. Arthritis Rheumatol 71:1174–1184

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  72. 72.

    Saag KG, Shane E, Boonen S et al (2007) Teriparatide or alendronate in glucocorticoid-induced osteoporosis. N Engl J Med 357:2028–2039

    CAS  PubMed  Article  Google Scholar 

  73. 73.

    Saag KG, Wagman RB, Geusens P et al (2018) Denosumab versus risedronate in glucocorticoid-induced osteoporosis: a multicentre, randomised, double-blind, active-controlled, double-dummy, non-inferiority study. Lancet Diabetes Endocrinol 6:445–454

    CAS  PubMed  Article  Google Scholar 

  74. 74.

    Saag KG, Zanchetta JR, Devogelaer JP et al (2009) Effects of teriparatide versus alendronate for treating glucocorticoid-induced osteoporosis: thirty-six-month results of a randomized, double-blind, controlled trial. Arthritis Rheum 60:3346–3355

    CAS  PubMed  Article  Google Scholar 

  75. 75.

    Salerno A, Hermann R (2006) Efficacy and safety of steroid use for postoperative pain relief. Update and review of the medical literature. J Bone Joint Surg Am 88:1361–1372

    PubMed  Article  Google Scholar 

  76. 76.

    Sambrook P, Birmingham J, Kelly P et al (1993) Prevention of corticosteroid osteoporosis. A comparison of calcium, calcitriol, and calcitonin. N Engl J Med 328:1747–1752

    CAS  PubMed  Article  Google Scholar 

  77. 77.

    Sambrook PN, Roux C, Devogelaer JP et al (2012) Bisphosphonates and glucocorticoid osteoporosis in men: results of a randomized controlled trial comparing zoledronic acid with risedronate. Bone 50:289–295

    CAS  PubMed  Article  Google Scholar 

  78. 78.

    Shane E, Cohen A, Stein EM et al (2012) Zoledronic acid versus alendronate for the prevention of bone loss after heart or liver transplantation. J Clin Endocrinol Metab 97:4481–4490

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  79. 79.

    Shin K, Park SH, Park W et al (2017) Monthly oral ibandronate reduces bone loss in Korean women with rheumatoid arthritis and osteopenia receiving long-term glucocorticoids: a 48-week double-blinded randomized placebo-controlled investigator-initiated trial. Clin Ther 39:268–278.e2

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  80. 80.

    Solomon DH, Katz JN, Jacobs JP et al (2002) Management of glucocorticoid-induced osteoporosis in patients with rheumatoid arthritis: rates and predictors of care in an academic rheumatology practice. Arthritis Rheum 46:3136–3142

    PubMed  Article  Google Scholar 

  81. 81.

    Steinbuch M, Youket TE, Cohen S (2004) Oral glucocorticoid use is associated with an increased risk of fracture. Osteoporos Int 15:323–328

    CAS  PubMed  Article  Google Scholar 

  82. 82.

    Stoch SA, Saag KG, Greenwald M et al (2009) Once-weekly oral alendronate 70 mg in patients with glucocorticoid-induced bone loss: a 12-month randomized, placebo-controlled clinical trial. J Rheumatol 36:1705–1714

    CAS  PubMed  Article  Google Scholar 

  83. 83.

    Suzuki Y, Nawata H, Soen S et al (2014) Guidelines on the management and treatment of glucocorticoid-induced osteoporosis of the Japanese society for bone and mineral research: 2014 update. J Bone Miner Metab 32:337–350

    PubMed  Article  Google Scholar 

  84. 84.

    Tee SI, Yosipovitch G, Chan YC et al (2012) Prevention of glucocorticoid-induced osteoporosis in immunobullous diseases with alendronate: a randomized, double-blind, placebo-controlled study. Arch Dermatol 148:307–314

    CAS  PubMed  Article  Google Scholar 

  85. 85.

    Torregrosa JV, Fuster D, Gentil MA et al (2010) Open-label trial: effect of weekly risedronate immediately after transplantation in kidney recipients. Transplantation 89:1476–1481

    CAS  PubMed  Article  Google Scholar 

  86. 86.

    Trijau S, de Lamotte G, Pradel V et al (2016) Osteoporosis prevention among chronic glucocorticoid users: results from a public health insurance database. RMD Open 2:e249

    PubMed  PubMed Central  Article  Google Scholar 

  87. 87.

    Van Hemelrijck M, Michaelsson K, Linseisen J et al (2013) Calcium intake and serum concentration in relation to risk of cardiovascular death in NHANES III. PLoS One 8:e61037

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  88. 88.

    Van Staa TP, Laan RF, Barton IP et al (2003) Bone density threshold and other predictors of vertebral fracture in patients receiving oral glucocorticoid therapy. Arthritis Rheum 48:3224–3229

    CAS  PubMed  Article  Google Scholar 

  89. 89.

    van Staa TP, Leufkens HG, Abenhaim L et al (2000) Oral corticosteroids and fracture risk: relationship to daily and cumulative doses. Rheumatology (Oxford) 39:1383–1389

    Article  Google Scholar 

  90. 90.

    Van Staa TP, Leufkens HG, Abenhaim L et al (2000) Use of oral corticosteroids and risk of fractures. J Bone Miner Res 15:993–1000

    CAS  PubMed  Article  Google Scholar 

  91. 91.

    van Staa TP, Leufkens HG, Cooper C (2002) The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int 13:777–787

    PubMed  Article  Google Scholar 

  92. 92.

    Wallach S, Cohen S, Reid DM et al (2000) Effects of risedronate treatment on bone density and vertebral fracture in patients on corticosteroid therapy. Calcif Tissue Int 67:277–285

    CAS  PubMed  Article  Google Scholar 

  93. 93.

    Xiao Q, Murphy RA, Houston DK et al (2013) Dietary and supplemental calcium intake and cardiovascular disease mortality: the national institutes of health-AARP diet and health study. JAMA Intern Med 173:639–646

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  94. 94.

    Yamada S, Takagi H, Tsuchiya H et al (2007) Comparative studies on effect of risedronate and alfacalcidol against glucocorticoid-induced osteoporosis in rheumatoid arthritic patients. Yakugaku Zasshi 127:1491–1496

    CAS  PubMed  Article  Google Scholar 

  95. 95.

    Yanbeiy ZA, Hansen KE (2019) Denosumab in the treatment of glucocorticoid-induced osteoporosis: a systematic review and meta-analysis. Drug Des Devel Ther 13:2843–2852

    CAS  PubMed  PubMed Central  Article  Google Scholar 

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Correspondence to Jan Leipe.

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J. Leipe, J.U. Holle, C. Weseloh, A. Pfeil, and K. Krüger declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

The supplement containing this article is not sponsored by industry.

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Leipe, J., Holle, J.U., Weseloh, C. et al. German Society of Rheumatology recommendations for management of glucocorticoid-induced osteoporosis. Z Rheumatol (2021). https://doi.org/10.1007/s00393-021-01025-z

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Keywords

  • Rheumatic disease
  • Bone mineral density loss
  • Osteoporosis
  • Glucocorticoids
  • Long-term treatment

Schlüsselwörter

  • Rheumatische Erkrankungen
  • Knochenmineraldichteverlust
  • Osteoporose
  • Glukokortikoide
  • Langzeittherapie