Management of glucocorticoid-induced osteoporosis in accordance with recent recommendations of the American Сollege of Rheumatology (ACR’2017)

Abstract

Glucocorticoid-induced osteoporosis is a metabolic bone disease that develops in the course of treatment with glucocorticoids because of their negative effect on both bone remodeling processes — osteoblast-mediated formation and osteoclast-mediated bone resorption — followed by the development of bone fractures. Bone fractures are diagnosed in more than 10% of patients receiving long-term glucocorticoid therapy, and vertebral fractures are detected in 30-40% of patients with radiological examination. According to the latest guidelines the development of glucocorticoid-induced osteoporosis is considered in cases when glucocorticoids are taken at a dose of ≥2.5 mg (in prednisolone equivalent) for 3 months or more. The latest recommendations (released in 2017) of the American College of Rheumatology (ACR) on management and treatment of patients with glucocorticoid-induced osteoporosis are presented. The basis of management is the stratification of fracture risk in patients who take long-term (more than 6 months) glucocorticoids at a dose of ≥7.5 mg/day (in prednisolone equivalent). The primary assessment of the risk of fractures is necessary during the first 6 months from the start of glucocorticoid therapy, subsequent risk reassessments are carried out at different times depending on the initial risk. According to the recommendations, all patients need to optimize the intake of calcium (1000-1200 mg/day) and vitamin D (600-800 IU/day), and also to modify the lifestyle. Аntiresorptive treatment with oral bisphosphonates in patients with the high/ medium fractures risk is recommended. The use of drugs with a different mechanism of action or intravenous bisphosphonates is recommended depending on the risk of fractures, the clinical situation and the evidence base. The article presents recommendations
for patients with glucocorticoid-induced osteoporosis, which vary depending on the age: approaches to the treatment of patients older and younger than 40 years are different.