What are the American College of Rheumatology (ACR) guidelines for the treatment of glucocorticoid-induced osteoporosis?

Updated: Jan 20, 2021
  • Author: Rachel Elizabeth Whitaker Elam, MD, MSc; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Guidelines from the American College of Rheumatology for the treatment of glucocorticoid-induced osteoporosis include the following [12] :

  • Designation of moderate-to-high risk or low-risk categories for adults ≥40 years of age receiving long term glucocorticoids by fracture risk score (using the  FRAX score)
  • No tools to estimate absolute fracture risk in children or adults ≤40 years of age. Considered high risk if previously sustained osteoporotic fracture and moderate risk if on glucocorticoid treatment ≥7.5 mg for 6 months and had either hip or spine BMD Z-score less than -3 or 2 or rapidly declining hip or spine BMD ≥ 10% in one year while on glucocorticoid treatment
  • Strong or conditional recommendations for initiation of treatment in women with non-childbearing potential and men on glucocorticoids with high, moderate, to low fracture risk in order of preference: oral bisphosphonates, IV bisphosphonates, teriparatide, denosumab, and raloxifene

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