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. |