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.
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.”
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.