Prevention of glucocorticoid induced osteoporosis

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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