Patients who have commitment or exposure to oral glucocorticoids for greater than three months (or treated for combined total of three months a year e.g. COPD patients) at any dose.
If a patient has an eGFR less than 30mL/min, do not treat without appropriate specialist advice, refer to renal team if patient not already known to them
Aged 65 years or older or
Aged less than 65 years and has a definite history of previous fragility fracture:
- Treat
- Calcium plus vitamin D and either alendronic acid 70mg weekly or risedronate 35mg weekly
- For more information and second-line treatments see 6.6 Drugs affecting bone metabolism
- Lifestyle advice (see below)
- Once the patient completely stops the corticosteroid, consider a DXA scan to guide whether bisphosphonates should be discontinued
Aged less than 65 years, no history of previous fragility fracture:
- Perform DXA scan:
- T score equal to or greater than -1.5, treat as above
- T score less than -1.5, consider treating with calcium and vitamin D whilst on steroids unless confident patient is replete
- Lifestyle advice (see below)
- Consider further scan in a minimum of 2 years if patient remains on corticosteroids
Lifestyle advice
- Weight bearing exercise, 20 minutes three times a week
- Healthy balanced diet. Encourage calcium rich foods if not taking calcium and vitamin D
- Stop smoking
- Sensible alcohol consumption, maximum 2 units daily for women or 3 units for men
- Daylight exposure, face and arms for 20 minutes daily three times a week.
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6. Endocrine >
Prevention of glucocorticoid induced osteoporosis
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