On "2015 Guidelines for Prevention and Treatment of Osteoporosis". Drug-induced osteoporosis: glucocorticoid-induced osteoporosis

Abstract

Osteoporosis is the most common and important adverse effect of glucocorticoid (GC) therapy. Since GC-induced bone loss is most rapid during the initial 3 - 6 months and primary prevention of bone loss is especially important, guidelines for management of GC-induced osteoporosis have been published overseas and in Japan. The Japanese Society for Bone and Mineral Research (JSBMR) has updated the Guidelines on the Management and Treatment of Glucocorticoid-induced Osteoporosis (GIO) and has incorporated a new scoring method. By analyzing five Japanese GIO cohorts from primary and secondary prevention studies, age, GC dose, lumbar BMD, and prior fragility fractures were identified as factors predicting future fracture and the fracture risk for an individual can be calculated as the sum of the scores for each risk factor. The guidelines were updated on the basis of a score of 3 as the optimal cut-off score for pharmacological intervention. Among the agents approved for the treatment of osteoporosis in Japan, the committee comprehensively reviewed validity for both primary and secondary prevention and assessed the benefit for both BMD and fracture prevention based on the results of clinical studies. Both alendronate and risedronate are recommended as first-line treatment. Ibandronate, teriparatide, and active vitamin D3 derivatives are recommended as alternative option.