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Table 9 Management of Glucocorticoid-Induced Osteoporosis [42].

From: Management of osteoporosis

Patient beginning therapy with glucocorticoid (prednisone equivalent of ≥5 mg/day with plans for treatment duration of ≥3 months):
1. Modify lifestyle risk factors for osteoporosis (Smoking cessation or avoidance. Reduction of alcohol consumption if excessive.)
2. Instruct in weight-bearing physical exercise.
3. Initiate calcium supplementation.
4. Initiate supplementation with vitamin D (plain or activated form).
5. Prescribe bisphosphonate (use with caution in premenopausal women).
Patient receiving long-term glucocorticoid therapy (prednisone equivalent of ≥5 mg/day):
1. Modify lifestyle risk factors for osteoporosis. (Smoking cessation or avoidance. Reduction of alcohol consumption if excessive.)
2. Instruct in weight-bearing physical exercise.
3. Initiate calcium supplementation.
4. Initiate supplementation with vitamin D (plain or activated form).
5. Prescribe treatment to replace gonadal sex hormones if deficient or otherwise clinically indicated.
6. Measure bone mineral density (BMD) at the lumbar spine and/or hip.
If BMD is not normal (i.e., T-score < -1.0), then prescribe bisphosphonate (use with caution in premenopausal women). Consider calcitonin as second-line agent if patient has contraindication or intolerance to bisphosphonate therapy.
If BMD is normal, follow-up and repeat BMD measurement annually or biannually.
  1. The devastating effects of glucocorticoids on bone can be largely mitigated by early intervention with bone-protective agents.