ACR Updates Guideline on GC-Induced Osteoporosis

The American College of Rheumatology (ACR) released their updated guidelines regarding glucocorticoid (GC)-induced osteoporosis, which provides more flexibility on drug selection and accounting for patient and physician preferences.

“The previous guideline rank-ordered medication for the treatment of glucocorticoid-induced osteoporosis. We felt it was important that this guideline reflect patient/physician decision making,” said Mary Beth Humphrey, MD, PhD, coprincipal investigator of the guideline and interim vice president for research and professor of medicine at the University of Oklahoma Health Sciences Center.

Glucocorticoids are used to treat a variety of inflammatory conditions. Patients treated with GCs who also have other risk factors for osteoporosis may be at significantly higher risk of of developing GC-induced osteoporosis.

“One major side effect of glucocorticoid therapy is bone loss and an increase in the risk of fractures. Fractures can cause significant morbidity and be associated with an increased risk of mortality,” said Dr Humphrey. “With newly approved osteoporosis medications and a review of the relevant literature, we felt it was important to update the guideline.”

Based on multiple study designs, long-term follow-up studies, and new clinical trials, the updated guideline advises the use of sequential therapy among patients at risk of GC-induced osteoporosis. Sequential therapy, which was not included in the 2017 guideline, has proved to be crucial in completing a course of denosumab, romosozumab, or parathyroid hormone and parathyroid hormone-related protein analog therapy, according to Linda Russell, MD, director of the Osteoporosis and Metabolic Bone Health Center at the Hospital for Special Surgery and coprincipal investigator of the guideline. She stressed that if patients skip the sequential therapy, they may be at a risk of rapidly developing vertebral fractures and bone loss.

The full guideline is available here.

—Priyam Vora

Reference:
2022 American College of Rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis (GIOP). News Release. American College of Rheumatology; September 14, 2022. [Prevention and Treatment of Glucocorticoid-Induced Osteoporosis