TY - JOUR
T1 - 2022 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis
AU - Humphrey, Mary Beth
AU - Russell, Linda
AU - Danila, Maria I.
AU - Fink, Howard A.
AU - Guyatt, Gordon
AU - Cannon, Michael
AU - Caplan, Liron
AU - Gore, Sara
AU - Grossman, Jennifer
AU - Hansen, Karen E.
AU - Lane, Nancy E.
AU - Ma, Nina S.
AU - Magrey, Marina
AU - McAlindon, Tim
AU - Robinson, Angela Byun
AU - Saha, Sumona
AU - Womack, Charles
AU - Abdulhadi, Basma
AU - Charles, Julia F.
AU - Cheah, Jonathan T.L.
AU - Chou, Sharon
AU - Goyal, Itivrita
AU - Haseltine, Katherine
AU - Jackson, Lesley
AU - Mirza, Reza
AU - Moledina, Iram
AU - Punni, Emma
AU - Rinden, Tim
AU - Turgunbaev, Marat
AU - Wysham, Katherine
AU - Turner, Amy S.
AU - Uhl, Stacey
N1 - Publisher Copyright:
© 2023 American College of Rheumatology. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.
PY - 2023/12
Y1 - 2023/12
N2 - Objective: The objective is to update recommendations for prevention and treatment of glucocorticoid-induced osteoporosis (GIOP) for patients with rheumatic or nonrheumatic conditions receiving >3 months treatment with glucocorticoids (GCs) ≥2.5 mg daily. Methods: An updated systematic literature review was performed for clinical questions on nonpharmacologic, pharmacologic treatments, discontinuation of medications, and sequential therapy. Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the certainty of evidence. A Voting Panel achieved ≥70% consensus on the direction (for or against) and strength (strong or conditional) of recommendations. Results: For adults beginning or continuing >3 months of GC treatment, we strongly recommend as soon as possible after initiation of GCs, initial assessment of fracture risks with clinical fracture assessment, bone mineral density with vertebral fracture assessment or spinal x-ray, and Fracture Risk Assessment Tool if ≥40 years old. For adults at medium, high, or very high fracture risk, we strongly recommend pharmacologic treatment. Choice of oral or intravenous bisphosphonates, denosumab, or parathyroid hormone analogs should be made by shared decision-making. Anabolic agents are conditionally recommended as initial therapy for those with high and very high fracture risk. Recommendations are made for special populations, including children, people with organ transplants, people who may become pregnant, and people receiving very high-dose GC treatment. New recommendations for both discontinuation of osteoporosis therapy and sequential therapies are included. Conclusion: This guideline provides direction for clinicians and patients making treatment decisions for management of GIOP. These recommendations should not be used to limit or deny access to therapies.
AB - Objective: The objective is to update recommendations for prevention and treatment of glucocorticoid-induced osteoporosis (GIOP) for patients with rheumatic or nonrheumatic conditions receiving >3 months treatment with glucocorticoids (GCs) ≥2.5 mg daily. Methods: An updated systematic literature review was performed for clinical questions on nonpharmacologic, pharmacologic treatments, discontinuation of medications, and sequential therapy. Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the certainty of evidence. A Voting Panel achieved ≥70% consensus on the direction (for or against) and strength (strong or conditional) of recommendations. Results: For adults beginning or continuing >3 months of GC treatment, we strongly recommend as soon as possible after initiation of GCs, initial assessment of fracture risks with clinical fracture assessment, bone mineral density with vertebral fracture assessment or spinal x-ray, and Fracture Risk Assessment Tool if ≥40 years old. For adults at medium, high, or very high fracture risk, we strongly recommend pharmacologic treatment. Choice of oral or intravenous bisphosphonates, denosumab, or parathyroid hormone analogs should be made by shared decision-making. Anabolic agents are conditionally recommended as initial therapy for those with high and very high fracture risk. Recommendations are made for special populations, including children, people with organ transplants, people who may become pregnant, and people receiving very high-dose GC treatment. New recommendations for both discontinuation of osteoporosis therapy and sequential therapies are included. Conclusion: This guideline provides direction for clinicians and patients making treatment decisions for management of GIOP. These recommendations should not be used to limit or deny access to therapies.
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U2 - 10.1002/acr.25240
DO - 10.1002/acr.25240
M3 - Article
C2 - 37884467
AN - SCOPUS:85174963207
SN - 2151-464X
VL - 75
SP - 2405
EP - 2419
JO - Arthritis Care and Research
JF - Arthritis Care and Research
IS - 12
ER -