The 2023 Guidelines for the management and treatment of glucocorticoid-induced osteoporosis

• Published in: Journal of bone and mineral metabolism Vol. 42; no. 2; pp. 143 - 154
• Main Authors: Tanaka, Yoshiya, Soen, Satoshi, Hirata, Shintaro, Okada, Yosuke, Fujiwara, Saeko, Tanaka, Ikuko, Kitajima, Yuriko, Kubota, Takuo, Ebina, Kosuke, Takashi, Yuichi, Inoue, Reiko, Yamauchi, Mika, Okubo, Naoaki, Ueno, Masanobu, Ohata, Yasuhisa, Ito, Nobuaki, Ozono, Keiichi, Nakayama, Hisanori, Terauchi, Masakazu, Tanaka, Sakae, Fukumoto, Seiji
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01-03-2024; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Bisphosphonates; Bone Density; Bone Density Conservation Agents - therapeutic use; Bone mineral density; Conferences; Delphi method; Disease management; Estrogen receptors; Fractures; Fractures, Bone - drug therapy; Glucocorticoids; Guideline; Humans; Infant; Medicine; Medicine & Public Health; Metabolic Diseases; Orthopedics; Osteoporosis; Osteoporosis - chemically induced; Osteoporosis - drug therapy; Osteoporosis - prevention & control; Parathyroid hormone; Patients; Quality of Life; Risk factors; Selective estrogen receptor modulators; Osteoporosis; Glucocorticoid-induced osteoporosis; Fracture; Treatment; Glucocorticoid
• ISSN: 0914-8779; 1435-5604; 1435-5604
• DOI: 10.1007/s00774-024-01502-w

Introduction
Although synthetic glucocorticoids (GCs) are commonly used to treat autoimmune and other diseases, GC induced osteoporosis (GIOP) which accounts for 25% of the adverse reactions, causes fractures in 30–50% of patients, and markedly decreases their quality of life. In 2014, the Japanese Society for Bone and Mineral Research (JSBMR) published the revised guidelines for the management and treatment of steroid-induced osteoporosis, providing the treatment criteria based on scores of risk factors, including previous fractures, age, GC doses, and bone mineral density, for patients aged ≥18 years who are receiving GC therapy or scheduled to receive GC therapy for ≥3 months.
Materials and methods
The Committee on the revision of the guidelines for the management and treatment of GIOP of the JSBMR prepared 17 clinical questions (CQs) according to the GRADE approach and revised the guidelines for the management and treatment of GIOP through systematic reviews and consensus conferences using the Delphi method.
Results
Bisphosphonates (oral and injectable formulations), anti-RANKL antibody teriparatide, eldecalcitol, or selective estrogen receptor modulators are recommended for patients who has received or scheduled for GC therapy with risk factor scores of ≥3. It is recommended that osteoporosis medication is started concomitantly with the GC therapy for the prevention of fragility fractures in elderly patients.
Conclusion
The 2023 guidelines for the management and treatment of GIOP was developed through systematic reviews and consensus conferences using the Delphi method.