Osteoporosis: Glucocorticoid-Induced

Key points

• Corticosteroid use is one of the most important risk factors for osteoporosis; given how widely these drugs are used, managing this risk appropriately is important
• UK practice follows the National Osteoporosis Guideline Group (NOGG) — currently the 2024 update of the UK clinical guideline for the prevention and treatment of osteoporosis, which superseded the older Royal College of Physicians guidance
• Risk is considered at an oral dose of about 7.5 mg prednisolone daily or equivalent, and rises with dose and duration; bone loss is fastest in the first few months of treatment
• Patients over 65, or with a previous fragility fracture, should be offered bone protection without waiting for a DEXA scan
• Other patients should have a DEXA scan, with treatment guided by the resulting T-score
• First-line treatment is generally an oral bisphosphonate (e.g. alendronate), alongside calcium and vitamin D supplementation