American College of Rheumatology recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis6
| I Patient beginning treatment with glucocorticoid (prednisone equivalent of 5 mg or more/day with plans for treatment duration of greater than or equal to 3 months) |
| • Modify lifestyle risk factors for osteoporosis |
| • Smoking cessation or avoidance |
| • Reduction of alcohol consumption if excessive |
| • Instruct in weightbearing physical exercise |
| • Initiate calcium supplementation |
| • Initiate supplementation with vitamin D (plain or activated form) |
| • Prescribe bisphosphonate (use with caution in premenopausal women) |
| II Patient receiving long term glucocorticoid treatment (prednisone equivalent of greater than or equal to 5 mg/day): |
| • Modify lifestyle risk factors for osteoporosis |
| • Smoking cessation or avoidance |
| • Reduction of alcohol consumption if excessive |
| • Instruct in weightbearing physical exercise |
| • Initiate calcium supplementation |
| • Initiate supplementation with vitamin D (plain or activated) |
| • Prescribe treatment to replace gonadal sex hormones if deficient or otherwise clinically indicated |
| • Measure bone mineral density (BMD) at lumbar spine or hip, or both |
| • If BMD is not normal (that is, T score below −1), then: |
| • Prescribe bisphosphonate (use with caution in premenopausal women) |
| • Consider calcitonin as second line agent if patient has a contraindication to, or does not tolerate, bisphosphonate treatment |
| • If BMD is normal, follow up and repeat BMD measurement either annually or biannually |