A UK Consensus Group on management of glucocorticoid‐induced osteoporosis: an update

Eastell, Richard; Reid, D. M.; Compston, Juliet; Cooper, Cyrus; Fogelman, Ignac; Francis, Roger M.; Hosking, David J.; Purdie, D. W.; Ralston, Stuart H.; Reeve, J.; Russell, R. G. G.; Stevenson, J. Court; Torgerson, David

doi:10.1046/j.1365-2796.1998.00408.x

Cited by 290 publications

(188 citation statements)

References 124 publications

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“…An exercise program should also be initiated, although this may be limited by restrictions from the underlying illness. Other published guidelines largely agree with the recommendations above, except for some minor differences 4142…”

Section: Specific Types Of Osteoporosissupporting

confidence: 58%

Updated Recommendations for the Diagnosis and Management of Osteoporosis: A Local Perspective

Raef

Al-Bugami

Balharith

et al. 2011

Annals of Saudi Medicine

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Postmenopausal osteoporosis and osteoporosis in elderly men are major health problems, with a significant medical and economic burden. Although osteopenia and osteoporosis are more common locally than in the West, fracture rates are generally less than in Western countries. Vitamin D deficiency is common in the region and contributes adversely to bone health. Vitamin D deficiency should be suspected and treated in all subjects with ostopenia or osteoporosis. The use of risk factors to determine fracture risk has been adopted by the World Health Organization and many international societies. Absolute fracture risk methodology improves the use of resources by targeting subjects at higher risk of fractures for screening and management. The King Faisal Specialist Hospital Osteoporosis Working Group recommends screening for women 65 years and older and for men 70 years and older. Younger subjects with clinical risk factors and persons with clinical evidence of osteoporosis or diseases leading to osteoporosis should also be screened. These guidelines provide recommendations for treatment for postmenopausal women and men older than 50 years presenting with osteoporotic fractures for persons having osteoporosis—after excluding secondary causes—or for persons having low bone mass and a high risk for fracture. The Working Group has suggested an algorithm to use at King Faisal Specialist Hospital that is based on the availability, cost, and level of evidence of various therapeutic modalities. Adequate calcium and vitamin D supplement are recommended for all. Weekly alendronate (in the absence of contraindications) is recommended as first-line therapy. Alternatives to alendronate are raloxifene or strontium ranelate. Second-line therapies are zoledronic acid intravenously once yearly, when oral therapy is not feasible or complicated by side effects, or teriparatide in established osteoporosis with fractures.

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Section: Specific Types Of Osteoporosissupporting

confidence: 58%

Updated Recommendations for the Diagnosis and Management of Osteoporosis: A Local Perspective

Raef

Al-Bugami

Balharith

et al. 2011

Annals of Saudi Medicine

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“…A diagnostic work-up, followed by therapeutic intervention, is advised for patients using oral corticosteroids at doses of 15 mg day x1 or more and those using doses between 7.5 and 15 mg day x1 and with strong risk factors for fracture. All other patients with doses of 7.5 mg or more should, according to these guidelines, be monitored periodically using bone-mass measurements [8]. These guidelines, based on a review of literature, were developed to provide a more systematic approach to the identi®cation of highrisk patients.…”

Section: Discussionmentioning

confidence: 99%

“…The evidence for the ef®cacy of these therapies has been summarized by Eastell [8]. Bisphosphonates have been most widely studied in patients with corticosteroid-induced osteoporosis.…”

Section: Discussionmentioning

confidence: 99%

Public health impact of adverse bone effects of oral corticosteroids

Staa

Abenhaim

Cooper

et al. 2001

Br J Clin Pharmacol

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Aims The objective of this study was to estimate the number of fractures attributed to oral corticosteroid use. Methods Information was obtained from the General Practice Research Database which contains medical records of general practitioners in the UK. The total number of corticosteroid-related fractures during a course of treatment was estimated using the formula for attributable risk among the exposed. Results A total of 244 235 patients was prescribed an oral corticosteroid. The rate of hip fractures increased exponentially with age in both males and females. The excess number of hip fracture cases among females aged 85 years or older using 7.5 mg prednisolone per day or more was 1.4 cases per 100 patients per year. About 47% of all hip and 72% of all vertebral fractures that occurred can be attributed to oral corticosteroid use. Among 10 000 female users of higher doses, 99.7 nonvertebral, 31.6 hip and 45.8 vertebral fractures can be attributed to use of oral corticosteroids. Conclusions The targeting of high-risk patients will be important for implementing preventative strategies in a cost-effective manner.

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“…However, considering the numbers per se, it is obvious that existing guidelines on the prevention and treatment of glucocorticoid-induced osteoporosis (34,(37)(38)(39) are only incompletely followed. In a recently published article, Solomon et al (40) reported that the practical implementation of such guidelines is not very consistent.…”

mentioning

confidence: 99%

Current use of glucocorticoids in patients with rheumatoid arthritis in Germany

Thiele¹,

Buttgereit²,

Huscher³

et al. 2005

Arthritis & Rheumatism

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Objective. To describe the current use of glucocorticoids in German patients with rheumatoid arthritis (RA). Methods. We analyzed clinical and patient-derived data from 10,068 outpatients with RA from the national database of the German Collaborative Arthritis Centres for the year 2001 collected by more than 80 rheumatologists in hospitals and private practices. Results. Systemic glucocorticoid therapy was prescribed for 60% of all patients with RA in rheumatologic care. The proportion of patients receiving systemic glucocorticoids in addition to disease-modifying antirheumatic drug (DMARD) therapy ranged from 53% to 81% of the patients for the various DMARDs. Glucocorticoid therapy was administered more often in combination with tumor necrosis factor inhibitors (81%), cyclosporin A (80%), or leflunomide (77%) than with more traditional DMARDs such as methotrexate (63%) or sulfasalazine (55%). Regarding the prevention and treatment of osteoporosis, 63% of patients taking systemic glucocorticoids were also receiving some type of osteoporosis therapy, as opposed to only 26% of those not taking glucocorticoids. Conclusion. Glucocorticoids play a pivotal role in the management of RA. This is reflected in the extensive use of low-dose glucocorticoids by German rheumatologists. Even if highly effective DMARDs are prescribed, they are accompanied by glucocorticoids, at least in the initial phase. High-dose glucocorticoids are prescribed for only a small proportion of the patients. There is increasing awareness of the risk of osteoporosis in long-term glucocorticoid treatment, demonstrated by the fact that osteoporosis medication is prescribed for a large proportion of patients taking glucocorticoids.

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A UK Consensus Group on management of glucocorticoid‐induced osteoporosis: an update

Cited by 290 publications

References 124 publications

Updated Recommendations for the Diagnosis and Management of Osteoporosis: A Local Perspective

Updated Recommendations for the Diagnosis and Management of Osteoporosis: A Local Perspective

Public health impact of adverse bone effects of oral corticosteroids

Current use of glucocorticoids in patients with rheumatoid arthritis in Germany

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