ACR recommendations for the prevention and treatment of prednisone-induced osteoporosis

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Recommendations for the Prevention and Treatment of

Glucocorticoid-induced Osteoporosis from the ACR, last updated in 2001:

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Patients beginning therapy with glucocorticoid (prednisone equivalent of

>5 mg/day) with plans for treatment duration of >3 months:

Modify lifestyle risk factors for osteoporosis:

Smoking cessation or avoidance

Reduction of alcohol consumption if excessive

Instruct in weight-bearing physical exercise

Initiate calcium supplementation

Initiate supplementation with vitamin D (plain or activated form)

Prescribe bisphosphonate (use with caution in premenopausal women)

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Patients receiving long-term glucocorticoid therapy (prednisone

equivalent of >5 mg/day):

Modify lifestyle risk factors for osteoporosis:

Smoking cessation or avoidance

Reduction of alcohol consumption if excessive

Instruct in weight-bearing physical exercise

Initiate calcium supplementation

Initiate supplementation with vitamin D (plain or activated form)

Prescribe treatment to replace gonadal sex hormones if deficient

or otherwise clinically indicated

Measure bone mineral density (BMD) at lumbar spine and/or hip

If bone mineral density is not normal (i.e., T-score below -1), then:

Prescribe bisphosphonate (use with caution in premenopausal

women)

Consider calcitonin as second-line agent if patient has

contraindication to or does not tolerate

bisphosphonate therapy

If bone mineral density is normal, follow up and repeat bone

mineral density measurement either annually or

biannually

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For more details, see the following link:

http://www.guideline.gov/summary/summary.aspx?ss=15 & doc_id=2934 & string