British and U.S. guidelines: agreement on steroid-induced osteoporosis tx.(Gynecology)

SNOWMASS, COLO. -- Consensus is emerging on both sides of the Atlantic regarding the prevention and treatment of glucocorticoid-induced osteoporosis.

Soon-to-be-published recommendations developed by the Southeast Alliance for Bone Health, a consortium of American endocrinologists and rheumatologists, are similar to guidelines developed independently in a joint effort by the Bone and Tooth Society of Great Britain, the National Osteoporosis Society, and the Royal College of Physicians. Dr. Kenneth G. Saag said at a symposium sponsored by the American College of Rheumatology.

The fact that both sets of guidelines adopt an evidence-based approach accounts for the high degree of concordance between the two, noted the rheumatologist, who has been involved in developing the Southeast Alliance preventive therapy algorithm.

Glucocorticoid-induced osteoporosis is an enormous clinical problem. Bone mineral density (BMD) declines precipitously once patients go on steroids. And it's estimated that at any given time, at least 1% of the population is on long-term corticosteroid therapy.

Compounding the problem is the likelihood that some of the conditions for which long-term corticosteroids are commonly prescribed can themselves cause bone loss. There are, for instance, persuasive data to show that rheumatoid arthritis and corticosteroids are independent risk factors for hip fracture, according to Dr. Saag, director of the Center for Education and Research on Therapeutics of Musculoskeletal Disorders at the University of Alabama, Birmingham.

Both the U.K. and Southeast Alliance guidelines apply only to patients expected to be on corticosteroids for at least 3 months, the threshold at which fracture risk has been shown to increase. Both sets of guidelines define within this population a higher-risk subgroup based on a history of atraumatic fractures or the presence of other clinical risk factors. The Southeast Alliance algorithm identifies these risk factors as age 70 years or more in men, being on more than 20 mg/day of corticosteroids for more than 3 months, being ...