The Rheumatologist
COVID-19 NewsACR Convergence
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Gout Resource Center
      • Axial Spondyloarthritis Resource Center
      • Psoriatic Arthritis
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Glucocorticoids a Fracture Risk at Any Dose

Glucocorticoids a Fracture Risk at Any Dose

March 18, 2011 • By Kathy Holliman

  • Tweet
  • Email
Print-Friendly Version / Save PDF

The ACR has published the “2010 Recommendations for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis.”1 An update to the 2001 recommendations, these new guidelines take into account new therapies and updated diagnostic approaches that have been developed since the 2001 recommendations were published, as well as new data on the therapies mentioned in the 2001 publication.

You Might Also Like
  • Bisphosphonates May Limit Fracture Risk in Users of Oral Glucocorticoids
  • Making of the Guidelines
  • Baseline Bone Measures Predict Risk of Fragility Fracture in Postmenopausal
Explore This Issue
March 2011
Also By This Author
  • Accelerating Medicines Partnership Targets Therapies for Rheumatoid Arthritis, Systemic Lupus Erythematosus

Jennifer M. Grossman, MD, principal investigator and coauthor of the recommendations, tells her patients that a glucocorticoid “is a good drug, but it’s also a bad drug at the same time. Most of us had thought that 2.5 mg per day was a pretty safe dose, but there are patients taking that dose who should be getting a prophylactic medication for osteoporosis.”

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

The 2010 recommendations make it clear that any dose of glucocorticoids for management of inflammatory conditions can be associated with significant morbidity and mortality. Decline in bone mineral density can begin within the first three months of use, will often peak by six months, and then will continue with ongoing use.

“Patients on glucocorticoids fracture at a higher bone mineral density than patients not on glucocorticoids,” says Dr. Grossman, associate clinical professor of medicine in the department of rheumatology at the David Geffen School of Medicine at the University of California, Los Angeles. “We should not be relying just on bone mineral density when deciding whether to use pharmacologic therapy with these patients,” she notes.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

The need to assess bone health beyond bone mineral density is an important change from the 2001 recommendations. The 2010 recommendations “try to incorporate different aspects that raise a patient’s threshold of fracture risk, which is really important in these complicated rheumatology patients,” she says.

Assess Risk Beyond FRAX Score

Figure 1: Recommendations for postmenopausal women and men age >50 years initiating or receiving glucocorticoid therapy.1
click for large version
Figure 1: Recommendations for postmenopausal women and men age >50 years initiating or receiving glucocorticoid therapy.1

Use of the Fracture Risk Assessment Tool (FRAX) can help determine a patient’s fracture risk, but it can give an incomplete assessment. “One of the factors not captured by FRAX is glucocorticoid dose. Instead it is listed as ‘ever’ or ‘never’ used. If you have someone on a much higher dose, such as 20 mg daily, you may want to consider osteoporosis prevention therapy in that patient,” regardless of their score on FRAX,” Dr. Grossman says. (See “Making of the Guidelines” for more on FRAX.)

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

Another issue with only using the FRAX score is that the degree of fracture risk calculated by FRAX is based on bone density value for the hip. Because glucocorticoid-treated patients frequently lose bone mass in the spine before the hip, a FRAX score may underestimate their risk of fracture. One new recommendation is that physicians consider ordering a vertebral fracture assessment for patients initiating or receiving 5 mg or more of prednisone daily because patients are often unaware that they have had a vertebral fracture.

Pages: 1 2 3 4 | Single Page

Filed Under: DMARDs & Immunosuppressives, Drug Updates Tagged With: bone, Fractures, Glucocorticoid-Induced Osteoporosis, Glucocorticoids, Guidelines, Osteoporosis, patient care, SteroidsIssue: March 2011

You Might Also Like:
  • Bisphosphonates May Limit Fracture Risk in Users of Oral Glucocorticoids
  • Making of the Guidelines
  • Baseline Bone Measures Predict Risk of Fragility Fracture in Postmenopausal
  • A New Approach to Fracture Prevention

ACR Convergence

Don’t miss rheumatology’s premier scientific meeting for anyone involved in research or the delivery of rheumatologic care or services.

Visit the ACR Convergence site »

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts site »

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use / Cookie Preferences

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2023 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)