Suggested guidelines for evaluation and treatment of glucocorticoid-induced osteoporosis for the Department of Veterans Affairs.
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.
Adler
Robert A
RA
Endocrinology Section (111-P), McGuire Veterans Affairs Medical Center, Richmond, VA 23249, USA. robert.adler@med.va.gov
Hochberg
Marc C
MC
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
D004164:Diphosphonates; D005938:Glucocorticoids; D010281:Parathyroid Hormone; D002118:Calcium; D011241:Prednisone