About 1% of the U.S. population is currently treated with chronic glucocorticoids, said Dr. Buckley.2 “We also know that bone loss is greatest in the first year of use and that the greatest loss is in the vertebral bone. We know the predictors of fractures include the pattern of glucocorticoid use, the dose and the duration.”
Vertebral fracture risk rises dramatically in patients who take high doses, or ≥7.5 mg/day and higher, and in those who have received a high cumulative dose over many years, or ≥5 gm.3 The guideline voting panel looked closely at available evidence on specific patient populations’ bone density changes and fracture risk, especially younger patients on very high doses, or >30 mg/day.
“Although very high doses of glucocorticoids are used only in a small [percentage] of the patients, the risk of fracture significantly increases with long-term, high-dose glucocorticoid treatment,” said Dr. Buckley. The average patient isn’t in this very high-dose group, but this group is where many fractures occur. As the dose increases, the risk increases. It is not unusual for rheumatologists to prescribe high doses, she added. On the other hand, evidence shows that once the patient’s glucocorticoid dose is discontinued, bone density can recover. “So the ability of bone density to improve spontaneously is an important consideration in younger patients,” she said. | ← Previous | | | Next → | Single Page