Management of Glucocorticoid Induced Osteoporosis. Written by Dr Richard Conway, Consultant Physician & Rheumatologist, St James’s Hospital

Glucocorticoids are currently an indispensable part of the treatment approach to a wide variety of medical conditions. While generally extremely effective, at least temporarily, the multitude of attendant adverse events associated with glucocorticoid use should see them viewed as “our best of drugs, our worst of drugs”. These adverse events included hypertension, diabetes mellitus, infection, weight gain, in addition to muscle weakness. And also of particular relevance to the current conversation, osteoporosis and increased fracture risk.1

Summary of Management of Glucocorticoid induced Osteoporosis

Therefore, Glucocorticoid-induced osteoporosis is a significant health problem with high rates of the negative consequence of fracture. However, many of these fractures are preventable with appropriate management. All individuals receiving long-term glucocorticoids therefore require fracture risk assessment and nonmedication strategies to improve bone health. The majority of those aged 40 years or older receiving long-term glucocorticoids will also require a bisphosphonate.

References

1. Proven A, Gabriel SE, Orces C, O’Fallon WM, Hunder GG. Glucocorticoid therapy in giant cell arteritis: duration and adverse outcomes. Arthritis and rheumatism. 2003;49(5):703-8.

2. Laan RF, van Riel PL, van de Putte  LB, van Erning LJ, van’t Hof MA, Lemmens JA. Low-dose prednisone induces rapid reversible axial bone loss in patients with rheumatoid arthritis. A randomized, controlled study. Annals of internal medicine. 1993;119(10):963-8.

3. Bolland MJ, Avenell A, Baron JA, Grey A, MacLennan GS, Gamble GD, et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: metaanalysis. BMJ (Clinical research ed). 2010;341:c3691.

4. Iuliano S, Poon S, Robbins J, Bui M, Wang X, De Groot L, et al. Effect of dietary sources of calcium and protein on hip fractures and falls. In older adults in residential care: cluster randomised controlled trial. BMJ (Clinical research ed). 2021;375:n2364.

5. Buckley L, Guyatt G, Fink HA, Cannon M, Grossman J, Hansen KE, et al. 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. Arthritis & rheumatology (Hoboken, NJ). 2017;69(8):1521-37.

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