Management of osteoporosis risk in adults receiving high-dose inhaled glucocorticoid therapy

Measure BMD (DXA) of hip and spine and serum 25-hydroxyvitamin D in the following high-risk patients at baseline

Anyone taking systemic glucocorticoids or high-dose inhaled glucocorticoids for ≥3 months

Postmenopausal women

Premenopausal women with amenorrhea

Men with hypogonadism

History of fragility fracture

BMI <18.5 kg/m²

Encourage an exercise program to improve strength and balance, including weight-bearing exercise

Encourage patients to avoid cigarette smoking and excess alcohol intake

Give calcium and vitamin D supplementation; most individuals require 1200 mg of elemental calcium daily (diet plus supplement) and 800 IU vitamin D daily

Select therapy based upon fracture risk, determined by BMD (eg, T score ≤–2.5), history of fragility fracture, or Fracture Risk Assessment Tool (FRAX)*

Measure BMD at the initiation of glucocorticoid therapy and after one year. If BMD is stable or improved, measure BMD less frequently (every two to three years) thereafter.

BMD: bone mineral density; DXA: dual-energy x-ray absorptiometry; BMI: body mass index.
* Refer to UpToDate topics on the evaluation, prevention, and treatment of glucocorticoid-induced osteoporosis and to the website for the FRAX tool (http://www.shef.ac.uk/FRAX).

Graphic 95505 Version 5.0

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Management of osteoporosis risk in adults receiving high-dose inhaled glucocorticoid therapy