1. 2022 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid‐Induced Osteoporosis
- Author
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Humphrey, Mary Beth, Russell, Linda, Danila, Maria I, Fink, Howard A, Guyatt, Gordon, Cannon, Michael, Caplan, Liron, Gore, Sara, Grossman, Jennifer, Hansen, Karen E, Lane, Nancy E, S., Nina, Magrey, Marina, McAlindon, Tim, Robinson, Angela Byun, Saha, Sumona, Womack, Charles, Abdulhadi, Basma, Charles, Julia F, Cheah, Jonathan TL, Chou, Sharon, Goyal, Itivrita, Haseltine, Katherine, Jackson, Lesley, Mirza, Reza, Moledina, Iram, Punni, Emma, Rinden, Tim, Turgunbaev, Marat, Wysham, Katherine, Turner, Amy S, and Uhl, Stacey
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Osteoporosis ,6.1 Pharmaceuticals ,Evaluation of treatments and therapeutic interventions ,Management of diseases and conditions ,7.3 Management and decision making ,Musculoskeletal ,Good Health and Well Being ,Adult ,Child ,Humans ,United States ,Rheumatology ,Glucocorticoids ,Bone Density ,Public Health and Health Services ,Psychology ,Clinical sciences ,Allied health and rehabilitation science - Abstract
ObjectiveThe objective is to update recommendations for prevention and treatment of glucocorticoid-induced osteoporosis (GIOP) for patients with rheumatic or nonrheumatic conditions receiving >3 months treatment with glucocorticoids (GCs) ≥2.5 mg daily.MethodsAn updated systematic literature review was performed for clinical questions on nonpharmacologic, pharmacologic treatments, discontinuation of medications, and sequential therapy. Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the certainty of evidence. A Voting Panel achieved ≥70% consensus on the direction (for or against) and strength (strong or conditional) of recommendations.ResultsFor adults beginning or continuing >3 months of GC treatment, we strongly recommend as soon as possible after initiation of GCs, initial assessment of fracture risks with clinical fracture assessment, bone mineral density with vertebral fracture assessment or spinal x-ray, and Fracture Risk Assessment Tool if ≥40 years old. For adults at medium, high, or very high fracture risk, we strongly recommend pharmacologic treatment. Choice of oral or intravenous bisphosphonates, denosumab, or parathyroid hormone analogs should be made by shared decision-making. Anabolic agents are conditionally recommended as initial therapy for those with high and very high fracture risk. Recommendations are made for special populations, including children, people with organ transplants, people who may become pregnant, and people receiving very high-dose GC treatment. New recommendations for both discontinuation of osteoporosis therapy and sequential therapies are included.ConclusionThis guideline provides direction for clinicians and patients making treatment decisions for management of GIOP. These recommendations should not be used to limit or deny access to therapies.
- Published
- 2023