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

Yoshiya Tanaka¹, Satoshi Soen², Shintaro Hirata³, Yosuke Okada⁴, Saeko Fujiwara⁵, Ikuko Tanaka⁶, Yuriko Kitajima⁷, Takuo Kubota⁸, Kosuke Ebina^{9

10}, Yuichi Takashi¹¹, Reiko Inoue¹², Mika Yamauchi¹³, Naoaki Okubo¹⁴, Masanobu Ueno¹⁴, Yasuhisa Ohata⁸, Nobuaki Ito^{15

16}, Keiichi Ozono⁸, Hisanori Nakayama¹⁷, Masakazu Terauchi¹⁸, Sakae Tanaka¹⁹, Seiji Fukumoto²⁰

Affiliations

¹ The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahata-Nishi, Kitakyushu, 807-8555, Japan. tanaka@med.uoeh-u.ac.jp.
² Soen Orthopaedics, Osteoporosis and Rheumatology Clinic, Kobe, Japan.
³ Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan.
⁴ Clinical Research Center, Hospital of the University of Occupational and Environmental Health, Kyoto, Japan.
⁵ Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan.
⁶ Initiative for Rheumatology & Osteoporosis, Nagoya Rheumatology Clinic, Nagoya, Japan.
⁷ Department of Obstetrics and Gynecology, Nagasaki University Hospital, Nagasaki, Japan.
⁸ Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.
⁹ Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
¹⁰ Department of Musculoskeletal Regenerative Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
¹¹ Department of Endocrinology and Diabetes Mellitus, Fukuoka University School of Medicine, Fukuoka, Japan.
¹² Third Department of Medicine, Teikyo University Chiba Medical Center, Chiba, Japan.
¹³ Research Institute for Metabolic Bone Diseases, Eikokai Ono Hospital, Ono, Japan.
¹⁴ The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahata-Nishi, Kitakyushu, 807-8555, Japan.
¹⁵ Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan.
¹⁶ Osteoporosis Center, The University of Tokyo Hospital, Tokyo, Japan.
¹⁷ Department of Rheumatology, Soshigayaokura-Clinic, Setagaya, Tokyo, Japan.
¹⁸ Department of Women's Health, Tokyo Medical and Dental University, Tokyo, Japan.
¹⁹ Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
²⁰ Fujii Memorial Institute of Medical Sciences, Institute of Advance Medical Sciences, Tokushima University, Tokushima, Japan.

PMID: 38538869
PMCID: PMC10982086
DOI: 10.1007/s00774-024-01502-w

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

Yoshiya Tanaka et al. J Bone Miner Metab. 2024 Mar.

. 2024 Mar;42(2):143-154.

doi: 10.1007/s00774-024-01502-w. Epub 2024 Mar 28.

Authors

Affiliations

¹ The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahata-Nishi, Kitakyushu, 807-8555, Japan. tanaka@med.uoeh-u.ac.jp.
² Soen Orthopaedics, Osteoporosis and Rheumatology Clinic, Kobe, Japan.
³ Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan.
⁴ Clinical Research Center, Hospital of the University of Occupational and Environmental Health, Kyoto, Japan.
⁵ Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan.
⁶ Initiative for Rheumatology & Osteoporosis, Nagoya Rheumatology Clinic, Nagoya, Japan.
⁷ Department of Obstetrics and Gynecology, Nagasaki University Hospital, Nagasaki, Japan.
⁸ Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.
⁹ Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
¹⁰ Department of Musculoskeletal Regenerative Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
¹¹ Department of Endocrinology and Diabetes Mellitus, Fukuoka University School of Medicine, Fukuoka, Japan.
¹² Third Department of Medicine, Teikyo University Chiba Medical Center, Chiba, Japan.
¹³ Research Institute for Metabolic Bone Diseases, Eikokai Ono Hospital, Ono, Japan.
¹⁴ The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahata-Nishi, Kitakyushu, 807-8555, Japan.
¹⁵ Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan.
¹⁶ Osteoporosis Center, The University of Tokyo Hospital, Tokyo, Japan.
¹⁷ Department of Rheumatology, Soshigayaokura-Clinic, Setagaya, Tokyo, Japan.
¹⁸ Department of Women's Health, Tokyo Medical and Dental University, Tokyo, Japan.
¹⁹ Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
²⁰ Fujii Memorial Institute of Medical Sciences, Institute of Advance Medical Sciences, Tokushima University, Tokushima, Japan.

PMID: 38538869
PMCID: PMC10982086
DOI: 10.1007/s00774-024-01502-w

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.

Keywords: Fracture; Glucocorticoid; Glucocorticoid-induced osteoporosis; Osteoporosis; Treatment.

PubMed Disclaimer

Conflict of interest statement

IT, YK, RI, NO, MU, YO, NI, HN and SeF do not have conflict of interests to be disclosed.

Figures

**Fig. 1**
The 2023 Guidelines for the Management and Treatment of Glucocorticoid-induced Osteoporosis published by the Japanese Society for Bone and Mineral Research. BMD bone mineral density, GC glucocorticoid, PSL prednisolone, YAM young adult means

See this image and copyright information in PMC

References

1. Saag KG (2003) Glucocorticoid-induced osteoporosis. Endocrinol Metab Clin N Am 32:135–157 - PubMed
1. Chotiyarnwong P, McCloskey EV (2020) Pathogenesis of glucocorticoid-induced osteoporosis and options for treatment. Nat Rev Endocrinol 16:437–447 - PubMed
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1. Chiodini I, Falchetti A, Merlotti D et al (2020) Updates in epidemiology, pathophysiology and management strategies of glucocorticoid-induced osteoporosis. Expert Rev Endocrinol Metab 15:283–298 - PubMed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Substances

LinkOut - more resources

Miscellaneous