Glucocorticoid Induced Osteoporosis and Management

ABSTRACT

@#Glucocorticoid-induced osteoporosis (GIOP) is a form of secondary osteoporosis caused by the intake of glucocorticoid medication. It is characterised by rapid bone loss and takes place soon after glucocorticoid therapy is initiated (three to six months). This results in increased fracture risk. The increased risk is observed in patients taking 5 mg/day prednisolone (or equivalent) for 3 months. Therefore, clinicians should use the lowest dose of glucocorticoid for the shortest duration of time to control or treat the disease and consider steroid-sparing agent when appropriate. Patients who appear cushingoid should be evaluated to exclude excess endogenous or exogenous source of glucocorticoid. They should be evaluated for complications of glucocorticoid, including GIOP. BMD Testing using DXA is recommended for assessment of fracture risk in patients who will be started on glucocorticoid for three months at 5 mg/day prednisolone or equivalent. Patients who are at moderate to high risk of fractures or rapid bone loss should be treated with bisphosphonate, denosumab or teriparatide therapy to reduce the risk of fractures.