title: Suggested guidelines for evaluation and treatment of glucocorticoid-induced osteoporosis for the Department of Veterans Affairs.
abstract: BACKGROUND
  Glucocorticoid-induced osteoporosis is an important disorder in the predominantly male US veteran population. Department of Veterans Affairs facilities vary considerably in evaluation and management of glucocorticoid-induced osteoporosis.
  
  
  METHODS
  We suggest how evaluation and management can take place in medical centers with and without bone mineral density measurements by dual energy x-ray absorptiometry (DXA). The proposed guidelines can be applied to other health care systems.
  
  
  RESULTS
  Use of DXA can help determine fracture risk for patients taking glucocorticoid therapy and for those starting therapy for at least 3 months. Patients with low bone mineral density should be treated with a bisphosponate as should all patients about to start prednisone treatment at a dose of 7.5 mg/d or more. In facilities without DXA, most patients should be treated with bisphosphonates, the cost of which is about $30 to $35 per month. In addition, the use of urinary calcium measurements is encouraged to determine which patients might benefit from augmented vitamin D and calcium supplementation.
  
  
  CONCLUSIONS
  Attention to fracture risk assessment in patients undergoing glucocorticoid therapy and timely bisphosphonate treatment should lead to fewer fractures.
authors.affiliation: Endocrinology Section (111-P), McGuire Veterans Affairs Medical Center, Richmond, VA 23249, USA. robert.adler@med.va.gov
authors.forename: Robert A
authors.initials: RA
authors.lastname: Adler
authors.forename: Marc C
authors.initials: MC
authors.lastname: Hochberg
mesh_terms: D015502:Absorptiometry, Photon; D002118:Calcium / Q000652:urine; D004164:Diphosphonates / Q000191:economics / Q000627:therapeutic use*; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control*; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D010024:Osteoporosis / Q000139:chemically induced / Q000150:complications / Q000191:economics / Q000628:therapy*; D010281:Parathyroid Hormone / Q000627:therapeutic use; D011241:Prednisone / Q000009:adverse effects*; D012507:Sarcoidosis / Q000150:complications; D014728:Veterans
chemical_list: D004164:Diphosphonates; D005938:Glucocorticoids; D010281:Parathyroid Hormone; D002118:Calcium; D011241:Prednisone