2014 update of recommendations on the prevention and treatment of glucocorticoid-induced osteoporosis

Abstract Objectives To update the recommendations on the prevention and treatment of glucocorticoid-induced osteoporosis issued in 2003 by the French National Authority for Health (HAS). This update was performed under the aegis of the Bone Section of the French Society for Rheumatology (SFR) and Os...

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Published inJoint, bone, spine : revue du rhumatisme Vol. 81; no. 6; pp. 493 - 501
Main Authors Briot, Karine, Cortet, Bernard, Roux, Christian, Fardet, Laurence, Abitbol, Vered, Bacchetta, Justine, Buchon, Daniel, Debiais, Françoise, Guggenbuhl, Pascal, Laroche, Michel, Legrand, Erik, Lespessailles, Eric, Marcelli, Christian, Weryha, Georges, Thomas, Thierry
Format Journal Article
LanguageEnglish
Published France Elsevier SAS 01.12.2014
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Summary:Abstract Objectives To update the recommendations on the prevention and treatment of glucocorticoid-induced osteoporosis issued in 2003 by the French National Authority for Health (HAS). This update was performed under the aegis of the Bone Section of the French Society for Rheumatology (SFR) and Osteoporosis Research and Information Group (GRIO), in collaboration with four French learned societies (primary-care, gastroenterology, internal medicine, and nephrology). Methods A task force composed of members of the medical specialties involved in managing patients with glucocorticoid-induced osteoporosis conducted a systematic literature review according to the method developed by the HAS then used the results to develop updated recommendations. Results These recommendations are intended for all physicians involved in the management of patients who are scheduled to start, or are taking, long-term glucocorticoid therapy (≥ 3 months) in any dose and for any reason. In postmenopausal women and men older than 50 years of age, treatment is warranted in the presence of any of the following risk factors for fracture: history of bone frailty fracture after 50 years of age, bone mineral density T-score ≤ −2.5 at one or more sites, age ≥ 70 years, and dosage ≥ 7.5 mg/d prednisone-equivalent for longer than 3 months. Bisphosphonates can be used in all these situations; teriparatide can be given as first-line therapy in patients at high fracture risk but is reimbursed by the French statutory health insurance system only in patients having two or more prevalent vertebral fractures. The fracture risk is lower in nonmenopausal women and in men younger than 50 years of age, in whom treatment decisions should rest on a case-by-case evaluation. Conclusion These recommendations are intended to clarify the pharmacological management of glucocorticoid-induced osteoporosis.
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ISSN:1297-319X
1778-7254
DOI:10.1016/j.jbspin.2014.10.001