Glucocorticoid-induced osteoporosis: analysis of the international guidelines for prevention and treatment.

Abstract

Glucocorticoid-induced osteoporosis (GIO) is the second cause after postmenopausal osteoporosis, and the most frequent of secondary osteoporosis.
Previously various scientific societies established guidelines for the treatment of GIO considering dose and time of glucocorticoid (GC) treatment and degrees of bone loss as measured by bone densitometry. Recently new guidelines of societies like the American College of Rheumatology (ACR), American Society of Bone and Mineral Research (ASBMR), International Osteoporosis Foundation (IOF), European Calcified Tissue Society (ECTS) present some changes. Some differences are: the consideration of higher doses of GC (7.5 mg/day); the stratification of the adult population in low, moderate or high risk of fracture determined by employing the FRAX tool or the presence of fracture risks; the time of GC use as parameters to recommend treatment in postmenopausal patient population and men ≥50 years. In premenopausal women or men ≤50 years the presence of a fragility fracture should be considered to start treatment. The possibility of treating fertile women is considered. All guidelines recommended adequate calcium intake and normal serum levels of vitamin D; and bisphosphonates appear as the drugs of first choice in the treatment of GIO. Different criteria are observed for therapeutic intervention in young populations treated with GC, patients without fractures, fertile women, adult population at low risk of fractures, and the possible use of alternative treatments such as teriparatide or denosumab in fertile women, according to the norms of different societies. In the present paper the ACR, ASBMR and IOF-ECTS guidelines for the management and treatment of GIO are presented in comparative form.