GUIDELINES - New guidelines for steroid-induced osteoporosis

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New guidelines for steroid-induced osteoporosis

Rheumawire

November 7, 2005

Janis

Brussels, Belgium - Dr Jean-Pierre Devogelaer and colleagues in the Belgian

Bone Club report a set of evidence-based guidelines for the prevention and

treatment of glucocorticoid (GC)-induced osteoporosis in Osteoporosis

International [1]. The guidelines largely validate what has been standard

practice for many clinicians but carry a heightened warning about the risk

of osteoporosis associated with even low doses of glucocorticoids.

" There is no safe GC dose. Bone-mineral density [bMD] should be checked soon

after start of GC therapy. Effective preventive therapy for osteoporosis

exists! " Devogelaer tells rheumawire.

Treatment, BMD monitoring recommended with GC use

The guidelines recommend that physicians treating patients on GCs:

Give all patients taking GCs supplemental calcium and vitamin D.

Urge them to exercise regularly and to avoid tobacco and alcohol.

Consider hormone-replacement therapy in young postmenopausal females

as well as in postmenopausal women and in men with low androgen levels.

Add calcitonin or bisphosphonates in cases of long-term GC use.

" These recommendations are not frankly different from the former ones, but

they are necessary because preventive therapy is still too infrequently

prescribed in prevention of GC osteoporosis, " Devogelaer says. He notes that

all patients on GCs are threatened with osteoporosis and that prevention

and/or therapy should be considered for osteopenic premenopausal females and

for males on a daily dose equivalent to 7.5 mg/day or more of prednisolone,

as well as for postmenopausal women.

The authors write, " Supplemental calcium and vitamin D should be considered

as the first-line therapy because of the decrease in intestinal calcium

absorption provoked by GCs. They also could be considered either as isolated

therapy in patients taking less than 7.5 mg prednisolone daily and/or for a

predicted period shorter than three months or as adjuvant therapy to other

more potent drugs. "

The guidelines recommend maintaining therapy as long as the patient is

taking GCs but note that it might be stopped after weaning from GCs because

there is evidence that BMD recovers when GCs are stopped.

The analysis did not demonstrate any benefit from combining two

antiresorptive agents or one antiresorptive agent plus an anabolic agent.

Several questions remain about the optimal agents and schedule for

preventing GC-related bone loss. Devogelaer pointed to the need for

prospective studies to determine the appropriate duration of bisphosphonate

therapy.

Source

Devogelaer JP, Goemaere S, Boonen S, et al. Evidence-based

guidelines for the prevention and treatment of glucocorticoid-induced

osteoporosis: a consensus document of the Belgian Bone Club. Osteoporos

Int2005; DOI: 10.1007/s00198-005-2032-z. Available at

http://www.springerlink.com.

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