Table 6.
The research agenda: key areas in the clinical management of GIOP requiring further research.
| AREA | SPECIFIC QUESTIONS |
|---|---|
| Epidemiology | What is the population and economic burden of GIOP and its impact on quality of life? |
| What is the contribution of glucocorticoid exposure and GIOP prevention to fracture risk in conditions other than RA, IBD and asthma/COPD, e.g. adrenal insufficiency, dermatological conditions, polymyalgia rheumatica or giant cell arteritis, immune thrombocytopenia or autoimmune hemolytic anemias? | |
| Appropriate use of glucocorticoids | What is the risk of GIOP and optimal prevention strategy with local use of glucocorticoids (e.g. inhaled, topical, intra-articular use)? |
| What is the efficacy on disease and GIOP risk of glucocorticoid-sparing alternatives in direct comparator studies, e.g. with biologicals or mTOR pathway inhibitors? | |
| What are optimal strategies to help close the treatment gap in GIOP? | |
| Non-pharmacological management | What are the optimal strategies, benefits and risks of patient education about GIOP? |
| What is the risk of falls and sarcopenia associated with chronic glucocorticoid use and how can it best be assessed? | |
| What is the effect of lifestyle, nutritional and/or exercise interventions on fracture and falls risk in GIOP? | |
| Are there alternative surgical procedures which can be used safely and effectively to treat vertebral compression fractures in GIOP? | |
| Laboratory evaluation | What is the value of laboratory evaluations in GIOP? |
| Fracture risk assessment | How can fracture risk assessment be improved e.g. using advanced imaging modalities, additional clinical risk factors, biomarkers or genetic risk profiles? |
| How can fracture risk assessment and treatment decisions be improved in premenopausal women (especially those of childbearing potential) and men < 40 years of age? | |
| Antiresorptives and bone anabolic drugs | What is the efficacy and safety of pharmacological GIOP prevention in endogenous hypercortisolism or diseases other than RA, IBD or transplant-associated osteoporosis? |
| What is the risk of osteonecrosis of the jaw and atypical femoral fractures during GIOP treatment, and how can we best manage patients who experience these adverse events? | |
| What is the efficacy and safety of combination and sequential therapy as well as sclerostin inhibition in GIOP? | |
| What are optimal strategies for long-term treatment with bisphosphonates or denosumab or transitions between these treatments in GIOP? | |
| Follow-up and monitoring | What is the clinical added value of DXA, TBS, BTMs and alternative bone strength assessment tools in the monitoring and follow-up of GIOP? |