The Webinar Series: Bone, Muscle & Beyond featured a Webinar on Glucocorticoid- Induced Osteoporosis (GIOP) on the7th May 2024. It was presented Prof. Julien Paccou (France) and Dr. Maria Yavropoulou (Greece), who have been leading the recent efforts of a working group of the ECTS to perform an updated review of existing literature on GIOP with the goal to provide recommendations on prevention and treatment of GIOP for non-bone specialists. Original articles of larger studies and systematic reviews with meta-analyses were prioritized for review.
The Webinar summarized basic findings and recommendations in a very succinct and clinically relevant manner. In detail the following aspects were covered:
-Who to assess?
Patients with an indication for or who have already started oral GSs for at least 3 months
- Postmenopausal women and men > 50 years
- Patients at high risk of fracture* (regardless of age, GC dosage and underlying disease)
high risk of fracture* = history of fragility fracture during adulthood / comorbidities that are frequently associated with osteoporosis
-How to assess?
- Measurement of BMD by DXA
- Systemic vertebral imaging (VFA)
- Osteoporosis risk factors including history of fragility fracture
- GCs dose-adjusted FRAX® and fall risk
-Who to treat?
Non-pharmacological measures for any patient on long-term oral GC treatment (>3 months)
- Use oral GCs at the lowest possible dosage and as short as possible
- Administration of GC locally (topical, inhaled, intra-articular) rather than systemically
- Optimal treatment of the underlying disease
- Adequate calcium intake (ca 1000 mg/d)
- Protein intake (at least 60 g/d)
- Vitamin D (to ensure concentration of > 20 ng/ml)
- Prevention of falls
- No smoking- limited alcohol intake
Pharmacological treatment
- Postmenopausal women and men > 50 years on CCs >3 months
- In the presence of a fragility fracture OR
- T-score <-1.5 OR
- GCs dosage > 7,5 mg/day OR
- Age >70 years OR
- GC dose-adjusted FRAX®
-How to treat?
- Treatment should be tailored according to patient preference, safety and level of Fx risk
- Medium risk of Fx: adults without recent history of Fx: ALN or RIS as the first line of treatment
- High risk of Fx: adults with recent history of Fx: ZOL or Dmab as the first line of treatment
- Very high risk of Fx: adults aged >70 with recent hip and/or pelvis and /or VFx: TPTD as the first-line of treatment
–When to do a reassessment when patients are receiving osteoporosis treatment?
- Annual clinical and biological follow-up
- Fall risk
- Systemic vertebral imaging
- Possibility of lowering the GC dosage
- DXA every 1-2 years initially and then every 2 years or more thereafter
–When to stop osteoporosis medication?
- Discontinuation of GCs in patients receiving treatment
- Re-evaluation of Fx risk to guide the decision
- In patients with no new Fx fracture, no new CRFs, and a current BMD T-score>-1.5