Glucocorticoid-Induced Osteoporosis and the New ACR Guideline

Abstract

Glucocorticoid-induced osteoporosis (GIOP) continues to be the most common cause of secondary osteoporosis because at any time about 1% of the adult population has been prescribed oral glucocorticoids. Surprisingly, there are relatively few treatment studies of GIOP, particularly of younger individuals including women of child bearing potential and children. Thus, recommendations for management of patients at risk for fracture or who have already suffered an osteoporotic fracture are often based more on clinical experience than randomized controlled trials. Nonetheless, organizations such as the American College of Rheumatology have provided guidance on management of GIOP. In this review, the treatment of GIOP is discussed in light of the specific pathophysiology of this disorder. What separates GIOP from other types of osteoporosis is the profound decrease in osteoblastic function and fact that 3 months (or less) of glucocorticoid therapy leads to a demonstrable increase in fracture incidence. The new ACR Guideline uses FRAX and bone mineral density to categorize fracture risks in GIOP and advocates use of oral bisphosphonates for most patients. Other new findings and alternative management approaches are also discussed.