Background In 2014, the Japanese Society for Bone and Mineral Research (JSBMR) updated their guidelines for the management and treatment of glucocorticoid-induced osteoporosis (GIO) and incorporated a new scoring method that does not use the Fracture Risk Assessment Tool (FRAX®).
Objectives In this study, using the JSBMR guidelines (1) and the American College of Rheumatology (ACR) 2010 recommendations (2) for the prevention and treatment of GIO, we compared our evaluations of Japanese patients with rheumatoid arthritis (RA) who were treated with glucocorticoids.
Methods The Institute of Rheumatology Rheumatoid Arthritis (IORRA) study, which began in 2000, was a prospective cohort study of RA patients conducted at the Institute of Rheumatology, Tokyo Women's Medical University (Tokyo, Japan). Applying ACR recommendations and JSBMR guidelines, we evaluated 1,752 of these Japanese patients who were over the age of 50 years (mean age 63 years) and had been treated with glucocorticoids. The ACR recommendation is to prescribe osteoporosis treatments for patients treated with ≥7.5 mg/day prednisolone or whose 10-year risk of major osteoporotic fractures is >10%. The Japanese GIO guidelines identify age, glucocorticoid dose, lumbar bone mineral density, and prior fragility fractures as factors predictive of bone fracture, and the fracture risk for an individual can be calculated as the sum of the scores for each risk factor with a score of 3 representing the optimal cut-off score for pharmacological intervention.
Results Among the female RA patients older than 50 years who were treated with glucocorticoids (n=1,438), in accordance with the ACR recommendations and the Japanese guidelines, 1,183 (82%) and 1,119 (78%) patients, respectively, should have received osteoporosis treatments (Table). Among the male RA patients older than 50 years who were treated with glucocorticoids (n=314), the ACR recommendations and the Japanese guidelines propose that 217 (69%) and 267 (85%) patients, respectively, should have received osteoporosis treatments (Table). Among the male patients, the Japanese guidelines would recommend significantly more patients receive osteoporosis treatments compared with the ACR recommendations (P<0.0001).
Conclusions The updated Japanese GIO guideline appears to be a simple and useful tool to use when treating Japanese RA patients with glucocorticoids. The ACR recommendations may have underestimated the need for osteoporosis treatment in male patients with RA compared with the Japanese guideline, although prospective studies are necessary to conclude.
Suzuki Y, et al. Guidelines on the management and treatment of glucocorticoid-induced osteoporosis of the Japanese Society for Bone and Mineral Research: 2014 update. J Bone Miner Metab. 2014;32(4):337–50;
Grossman JM, et al. American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res (Hoboken). 2010;62(11):1515–26.
Acknowledgement We thank Dr. Eisuke Inoue and all of the members of the Institute of Rheumatology, Tokyo Women's Medical University for the successful management of the IORRA cohort.
Disclosure of Interest T. Furuya: None declared, S. Momohara Grant/research support from: AbbVie, Inc., Asahi Kasei Pharma Corp., Bristol-Myers Squibb Co., Chugai Pharmaceutical Co., Daiichi Sankyo Co., Ltd., Eisai Co., Ltd., Mitsubishi Tanabe Pharma Co., Nakashima Medical Co., Ltd., Santen Pharmaceutical Co., Ltd., Taisho Toyama Pharmaceutical Co. Ltd. and Takeda Pharmaceutical Co., Ltd, A. Taniguchi: None declared, H. Yamanaka Grant/research support from: Abbott, AbbVie, Asahikasei, Astellas, AstraZeneca, Bristol-Myers Squib, Chugai, Daiichi Sankyo, Eisai, GlaxoSmithKline, Janssen, Mitsubishi Tanabe, MSD, Nippon Kayaku, Pfizer, Santen, Taishotoyama, Takeda, and Teijin; has received consulting fees from Abbott, AbbVie, Astellas, AstraZeneca, Bristol-Myers Squib, Chugai, Daiichi Sankyo, Eisai, Mitsubishi Tanabe, Nippon Kayaku, Pfizer, Takeda, and Teijin, Speakers bureau: Abbott, AbbVie, Astellas, Bristol-Myers Squib, Chugai, Eisai, Mitsubishi Tanabe, Pfizer, Takeda, and Teijin