Table 4.

Recommendations for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis

Patient beginning therapy with glucocorticoid (prednisone equivalent ≥ 5 mg/d) with plans for treatment of more than 3 months:

Modify lifestyle risk factors for osteoporosis

Smoking cessation or avoidance

Reduction of alcohol consumption if excessive

Instruct in weight-bearing physical exercise

Initiate calcium supplementation

Initiate supplementation with vitamin D (plain or activated form)

Prescribe bisphosphonate (use with caution in premenopausal women)

Patient receiving long-term glucocorticoid therapy (prednisone equivalent ≥ 5 mg/d):

Modify lifestyle risk factors for osteoporosis

Smoking cessation or avoidance

Reduction of alcohol consumption if excessive

Instruct in weight-bearing physical exercise

Initiate calcium supplementation

Initiate supplementation with vitamin D (plain or activated form)

Prescribe treatment to replace gonadal sex hormones if deficient or otherwise    clinically indicated

Measure BMD at lumbar spine and/or hip

If BMD is not normal (T-score below −1), then:

Prescribe bisphosphonate (use with caution in premenopausal women)

Consider calcitonin as second-line agent if patient has contraindication     to or does not tolerate bisphosphonate therapy

If BMD is normal, follow up and repeat BMD measurement either annually    or biannually

BMD, bone mineral density.

Adapted with permission from the American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis.³⁹