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The 2023 Guidelines for the management and treatment of glucocorticoid-induced osteoporosis

Japanese Society for Bone and Mineral Re… · 2024 · Japan

Source and licence

Authors
Yoshiya Tanaka, Satoshi Soen, Shintaro Hirata et al.
Title
The 2023 Guidelines for the management and treatment of glucocorticoid-induced osteoporosis
Journal
Journal of Bone and Mineral Metabolism, 2024
DOI
10.1007/s00774-024-01502-w
Licence
CC BY 4.0
Changes
Verbatim excerpts; formatting adapted

Full text retrieved 2026-10-27 from Europe PMC · PMC10982086

Licence statement of the original publication

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This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.

Open the original publication →Full text on Europe PMC

Recommendations

Verbatim, with grade of recommendation or strength of consensus where given.

Results

  • Patients with GIOP account for 0.7–1.2% of adults in the world. Since fractures occur in 30–50% of the patients and markedly impair their QOL, appropriate management and treatment of this disease are recommendedEvidence level: D; Recommendation grade: 1; Consensus level: 9.0
  • The risk factors of GIOP include advanced age, GC doses, low bone mineral density of the lumbar spine, presence of previous fractures, and no receipt of bisphosphonate therapy. It is recommended to implement appropriate management and treatment of GIOP without delay while attention is paid to these risk factorsEvidence level: D; Recommendation grade: 1; Consensus level: 9.0
  • Since the development of GIOP depends on the dose and duration of GC therapy, it is recommended to initiate the administration of GCs at the lowest dose possible and to immediately reduce the GC doses according to the pathological condition of the primary diseaseEvidence level: D; Recommendation grade: 1; Consensus level: 8.9
  • Although GIOP has no specific symptoms, vertebral fractures are useful for the diagnosis. It is recommended to evaluate whether there are vertebral fractures soon after initiating GC therapyEvidence level: D; Recommendation grade: 1; Consensus level: 8.6
  • During GC therapy, it is recommended to measure bone mineral density by dual-energy X-ray absorptiometry regularlyEvidence level: D; Recommendation grade: 1; Consensus level: 8.4
  • It is recommended to prioritize the treatment of the primary disease, which is the reason for the administration of GCs, and to guide lifestyle, including nutrition, according to the disease characteristics of the primary diseaseEvidence level: D; Recommendation grade: 1; Consensus level: 9.0
  • It is recommended to guide lifestyle and nutrition according to the Japanese guidelines for preventing and treating osteoporosisEvidence level: D; Recommendation grade: 1; Consensus level: 9.0
  • It is recommended to use the cut-off scores described in the “Guidelines on the management and treatment of GIOP of the JSBMR: 2014 update" as the criteria for initiating drug therapy for GIOPEvidence level: C; Recommendation grade: 1; Consensus level: 9.0
  • Active vitamin D preparations, such as eldecalcitol, are recommended because they effectively increase the bone mineral density of the lumbar spine and prevent non-vertebral fractures in patients scheduled to receive GC therapy and patients receiving GC therapyEvidence level: B; Recommendation grade: 1; Consensus level: 8.0
  • Bisphosphonates are recommended for patients scheduled to receive GC therapy or patients receiving GC therapy because there is evidence for the effects of bisphosphonates in increasing the bone mineral density of the lumbar spine and femur and preventing vertebral and non-vertebral fracturesEvidence level: A; Recommendation grade: 1; Consensus level: 9.0
  • Although there is no evidence that selective estrogen receptor modulators (SERMs) are effective for preventing vertebral or non-vertebral fractures in postmenopausal women at risk of GIOP, they are effective for increasing the bone mineral density of the lumbar spine and femur. Thus, the use of SERMs is proposedEvidence level: C; Recommendation grade: 2; Consensus level: 8.1
  • Parathyroid hormone 1 (PTH1) receptor agonists are recommended for patients at high risk of fractures because these agonists can be expected to be effective in increasing the bone mineral density of the lumbar spine and preventing vertebral fractures in patients scheduled to receive GC therapy and patients receiving GC therapyEvidence level: B; Recommendation grade: 1; Consensus level: 8.8
  • An anti-RANKL antibody should be administered to patients scheduled for or receiving GC therapy to increase lumbar spine and femur bone mineral density and prevent vertebral fracturesEvidence level: B; Recommendation grade: 1; Consensus level: 8.9
  • Recombinant teriparatide and an anti-RANKL antibody are more effective than bisphosphonates for preventing vertebral fractures. The use of the former drugs is recommended. Recombinant teriparatide is recommended for patients at high risk of fracturesEvidence level: B; Recommendation grade: 1; Consensus level: 8.0
  • Bisphosphonates are proposed for preventing and treating GIOP in childrenEvidence level: D; Recommendation grade: 2; Consensus level: 8.0
  • In elderly patients, intervention with anti-osteoporotic drugs in combination with GC therapy is recommended to prevent and treat fracturesEvidence level: D; Recommendation grade: 1; Consensus level: 8.1
  • It is recommended to guide lifestyle and nutrition to women of childbearing age who are scheduled to receive GC therapy and those who are receiving GC therapy, according to Guidelines on the management and treatment of GIOP of the JSBMR: 2014 updateEvidence level: D; Recommendation grade: 1; Consensus level: 8.3
  • It is recommended that bisphosphonates, an anti-RANKL antibody, and PTH1 receptor agonists should not be administered to pregnant or breastfeeding women for the treatment of GIOPEvidence level: D; Recommendation grade: 4; Consensus level: 8.3
  • For surgical treatment of fragility fractures attributable to GIOP, treatment strategies according to the treatment of primary osteoporosis are recommendedEvidence level: D; Recommendation grade: 1; Consensus level: 8.1

Abstract

Introduction: Although synthetic glucocorticoids (GCs) are commonly used to treat autoimmune and other diseases, GC induced osteoporosis (GIOP) which accounts for 25% of the adverse reactions, causes fractures in 30–50% of patients, and markedly decreases their quality of life. In 2014, the Japanese Society for Bone and Mineral Research (JSBMR) published the revised guidelines for the management and treatment of steroid-induced osteoporosis, providing the treatment criteria based on scores of risk factors, including previous fractures, age, GC doses, and bone mineral density, for patients aged ≥18 years who are receiving GC therapy or scheduled to receive GC therapy for ≥3 months.

Materials and methods: The Committee on the revision of the guidelines for the management and treatment of GIOP of the JSBMR prepared 17 clinical questions (CQs) according to the GRADE approach and revised the guidelines for the management and treatment of GIOP through systematic reviews and consensus conferences using the Delphi method.

Results: Bisphosphonates (oral and injectable formulations), anti-RANKL antibody teriparatide, eldecalcitol, or selective estrogen receptor modulators are recommended for patients who has received or scheduled for GC therapy with risk factor scores of ≥3. It is recommended that osteoporosis medication is started concomitantly with the GC therapy for the prevention of fragility fractures in elderly patients.

Conclusion: The 2023 guidelines for the management and treatment of GIOP was developed through systematic reviews and consensus conferences using the Delphi method.

Supplementary Information: The online version contains supplementary material available at 10.1007/s00774-024-01502-w.

Contents of the original publication

The section headings of the original.

  • Introduction
  • Materials and methods
  • Guideline development committee and policies
  • Guideline development process
  • Results
  • CQ 1: How many patients with GIOP are there? What are their QOL and outcomes?
  • Evidence level: D; recommendation grade: 1; consensus level: 9.0
  • CQ 2: What are the risk factors for GIOP?
  • Evidence level: D; recommendation grade: 1; consensus level: 9.0
  • CQ 3: How is the development of GIOP associated with the GC doses?
  • Evidence level: D; recommendation grade: 1; consensus level: 8.9
  • CQ 4: What are the symptoms, examinations, and imaging findings useful for diagnosing GIOP?
  • Evidence level: D; recommendation grade: 1; consensus level: 8.6
  • Evidence level: D; recommendation grade: 1; consensus level: 8.4
  • CQ 5: What is the guidance on lifestyle and nutrition for patients with GIOP?
  • Evidence level: D; recommendation grade: 1; consensus level: 9.0
  • Evidence level: D; recommendation grade: 1; consensus level: 9.0
  • CQ 6: What are the criteria for initiating drug therapy for GIOP?
  • Evidence level: C; recommendation grade: 1; consensus level: 9.0
  • CQ 7: Are active vitamin D preparations useful for treating GIOP?
  • Evidence level: B; recommendation grade: 1; consensus level: 8.0
  • CQ 8: Are bisphosphonates useful for the treatment of GIOP?
  • Evidence level: A; recommendation grade: 1; consensus level: 9.0
  • CQ 9: Are selective estrogen receptor modulators useful for the treatment of GIOP?
  • Evidence level: C; recommendation grade: 2; consensus level: 8.1
  • CQ 10: Are parathyroid hormone 1 receptor agonists useful in treating GIOP?
  • Evidence level: B; recommendation grade: 1; consensus level: 8.8
  • CQ 11: Is an anti-RANKL antibody useful for the treatment of GIOP?
  • Evidence level: B; recommendation grade: 1; consensus level: 8.9
  • CQ 12: Is an anti-sclerostin antibody useful for the treatment of GIOP?
  • CQ 13: Are the above-described drugs different in terms of usefulness?
  • Evidence level: B; recommendation grade: 1; consensus level: 8.0
  • CQ 14: How is GIOP prevented and treated in children?
  • Evidence level: D; recommendation grade: 2; consensus level: 8.0
  • CQ 15: How is GIOP prevented and treated in elderly patients?
  • Evidence level: D; recommendation grade: 1; consensus level: 8.1
  • CQ 16: How is GIOP prevented and treated in women of childbearing age?
  • Evidence level: D; recommendation grade: 1; consensus level: 8.3
  • Evidence level: D; recommendation grade: 4; consensus level: 8.3
  • CQ 17: What is the surgical treatment of fragility fractures associated with GIOP?
  • Evidence level: D; recommendation grade: 1; consensus level: 8.1
  • Conclusion

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