2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis

Lenore Buckley, Gordon Guyatt, Howard A. Fink, Michael Cannon, Jennifer Grossman, Karen E. Hansen, Mary Beth Humphrey, Nancy E. Lane, Marina Magrey, Marc Miller, Lake Morrison, Madhumathi Rao, Angela Byun Robinson, Sumona Saha, Susan Wolver, Raveendhara R. Bannuru, Elizaveta Vaysbrot, Mikala Osani, Marat Turgunbaev, Amy S. Miller & 1 others Timothy McAlindon

Research output: Contribution to journalArticle

  • 10 Citations

Abstract

Objective: To develop recommendations for prevention and treatment of glucocorticoid-induced osteoporosis (GIOP). Methods: We conducted a systematic review to synthesize the evidence for the benefits and harms of GIOP prevention and treatment options. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence. We used a group consensus process to determine the final recommendations and grade their strength. The guideline addresses initial assessment and reassessment in patients beginning or continuing long-term (≥3 months) glucocorticoid (GC) treatment, as well as the relative benefits and harms of lifestyle modification and of calcium, vitamin D, bisphosphonate, raloxifene, teriparatide, and denosumab treatment in the general adult population receiving long-term GC treatment, as well as in special populations of long-term GC users. Results: Because of limited evidence regarding the benefits and harms of interventions in GC users, most recommendations in this guideline are conditional (uncertain balance between benefits and harms). Recommendations include treating only with calcium and vitamin D in adults at low fracture risk, treating with calcium and vitamin D plus an additional osteoporosis medication (oral bisphosphonate preferred) in adults at moderate-to-high fracture risk, continuing calcium plus vitamin D but switching from an oral bisphosphonate to another antifracture medication in adults in whom oral bisphosphonate treatment is not appropriate, and continuing oral bisphosphonate treatment or switching to another antifracture medication in adults who complete a planned oral bisphosphonate regimen but continue to receive GC treatment. Recommendations for special populations, including children, people with organ transplants, women of childbearing potential, and people receiving very high-dose GC treatment, are also made. Conclusion: This guideline provides direction for clinicians and patients making treatment decisions. Clinicians and patients should use a shared decision-making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

LanguageEnglish (US)
Pages1095-1110
Number of pages16
JournalArthritis Care and Research
Volume69
Issue number8
DOIs
StatePublished - Aug 1 2017

Fingerprint

Glucocorticoids
Osteoporosis
Guidelines
Diphosphonates
Vitamin D
Therapeutics
Calcium
Decision Making
Teriparatide
Population
Group Processes
Patient Preference
Life Style
Comorbidity
Consensus
Transplants

Cite this

Buckley, L., Guyatt, G., Fink, H. A., Cannon, M., Grossman, J., Hansen, K. E., ... McAlindon, T. (2017). 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. Arthritis Care and Research, 69(8), 1095-1110. DOI: 10.1002/acr.23279

2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. / Buckley, Lenore; Guyatt, Gordon; Fink, Howard A.; Cannon, Michael; Grossman, Jennifer; Hansen, Karen E.; Humphrey, Mary Beth; Lane, Nancy E.; Magrey, Marina; Miller, Marc; Morrison, Lake; Rao, Madhumathi; Byun Robinson, Angela; Saha, Sumona; Wolver, Susan; Bannuru, Raveendhara R.; Vaysbrot, Elizaveta; Osani, Mikala; Turgunbaev, Marat; Miller, Amy S.; McAlindon, Timothy.

In: Arthritis Care and Research, Vol. 69, No. 8, 01.08.2017, p. 1095-1110.

Research output: Contribution to journalArticle

Buckley, L, Guyatt, G, Fink, HA, Cannon, M, Grossman, J, Hansen, KE, Humphrey, MB, Lane, NE, Magrey, M, Miller, M, Morrison, L, Rao, M, Byun Robinson, A, Saha, S, Wolver, S, Bannuru, RR, Vaysbrot, E, Osani, M, Turgunbaev, M, Miller, AS & McAlindon, T 2017, '2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis' Arthritis Care and Research, vol 69, no. 8, pp. 1095-1110. DOI: 10.1002/acr.23279
Buckley, Lenore ; Guyatt, Gordon ; Fink, Howard A. ; Cannon, Michael ; Grossman, Jennifer ; Hansen, Karen E. ; Humphrey, Mary Beth ; Lane, Nancy E. ; Magrey, Marina ; Miller, Marc ; Morrison, Lake ; Rao, Madhumathi ; Byun Robinson, Angela ; Saha, Sumona ; Wolver, Susan ; Bannuru, Raveendhara R. ; Vaysbrot, Elizaveta ; Osani, Mikala ; Turgunbaev, Marat ; Miller, Amy S. ; McAlindon, Timothy. / 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. In: Arthritis Care and Research. 2017 ; Vol. 69, No. 8. pp. 1095-1110
@article{e411549dc75346efb5aad2306b5eeaa7,
title = "2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis",
abstract = "Objective: To develop recommendations for prevention and treatment of glucocorticoid-induced osteoporosis (GIOP). Methods: We conducted a systematic review to synthesize the evidence for the benefits and harms of GIOP prevention and treatment options. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence. We used a group consensus process to determine the final recommendations and grade their strength. The guideline addresses initial assessment and reassessment in patients beginning or continuing long-term (≥3 months) glucocorticoid (GC) treatment, as well as the relative benefits and harms of lifestyle modification and of calcium, vitamin D, bisphosphonate, raloxifene, teriparatide, and denosumab treatment in the general adult population receiving long-term GC treatment, as well as in special populations of long-term GC users. Results: Because of limited evidence regarding the benefits and harms of interventions in GC users, most recommendations in this guideline are conditional (uncertain balance between benefits and harms). Recommendations include treating only with calcium and vitamin D in adults at low fracture risk, treating with calcium and vitamin D plus an additional osteoporosis medication (oral bisphosphonate preferred) in adults at moderate-to-high fracture risk, continuing calcium plus vitamin D but switching from an oral bisphosphonate to another antifracture medication in adults in whom oral bisphosphonate treatment is not appropriate, and continuing oral bisphosphonate treatment or switching to another antifracture medication in adults who complete a planned oral bisphosphonate regimen but continue to receive GC treatment. Recommendations for special populations, including children, people with organ transplants, women of childbearing potential, and people receiving very high-dose GC treatment, are also made. Conclusion: This guideline provides direction for clinicians and patients making treatment decisions. Clinicians and patients should use a shared decision-making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.",
author = "Lenore Buckley and Gordon Guyatt and Fink, {Howard A.} and Michael Cannon and Jennifer Grossman and Hansen, {Karen E.} and Humphrey, {Mary Beth} and Lane, {Nancy E.} and Marina Magrey and Marc Miller and Lake Morrison and Madhumathi Rao and {Byun Robinson}, Angela and Sumona Saha and Susan Wolver and Bannuru, {Raveendhara R.} and Elizaveta Vaysbrot and Mikala Osani and Marat Turgunbaev and Miller, {Amy S.} and Timothy McAlindon",
year = "2017",
month = "8",
day = "1",
doi = "10.1002/acr.23279",
language = "English (US)",
volume = "69",
pages = "1095--1110",
journal = "Arthritis Care and Research",
issn = "2151-464X",
number = "8",

}

TY - JOUR

T1 - 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis

AU - Buckley,Lenore

AU - Guyatt,Gordon

AU - Fink,Howard A.

AU - Cannon,Michael

AU - Grossman,Jennifer

AU - Hansen,Karen E.

AU - Humphrey,Mary Beth

AU - Lane,Nancy E.

AU - Magrey,Marina

AU - Miller,Marc

AU - Morrison,Lake

AU - Rao,Madhumathi

AU - Byun Robinson,Angela

AU - Saha,Sumona

AU - Wolver,Susan

AU - Bannuru,Raveendhara R.

AU - Vaysbrot,Elizaveta

AU - Osani,Mikala

AU - Turgunbaev,Marat

AU - Miller,Amy S.

AU - McAlindon,Timothy

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Objective: To develop recommendations for prevention and treatment of glucocorticoid-induced osteoporosis (GIOP). Methods: We conducted a systematic review to synthesize the evidence for the benefits and harms of GIOP prevention and treatment options. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence. We used a group consensus process to determine the final recommendations and grade their strength. The guideline addresses initial assessment and reassessment in patients beginning or continuing long-term (≥3 months) glucocorticoid (GC) treatment, as well as the relative benefits and harms of lifestyle modification and of calcium, vitamin D, bisphosphonate, raloxifene, teriparatide, and denosumab treatment in the general adult population receiving long-term GC treatment, as well as in special populations of long-term GC users. Results: Because of limited evidence regarding the benefits and harms of interventions in GC users, most recommendations in this guideline are conditional (uncertain balance between benefits and harms). Recommendations include treating only with calcium and vitamin D in adults at low fracture risk, treating with calcium and vitamin D plus an additional osteoporosis medication (oral bisphosphonate preferred) in adults at moderate-to-high fracture risk, continuing calcium plus vitamin D but switching from an oral bisphosphonate to another antifracture medication in adults in whom oral bisphosphonate treatment is not appropriate, and continuing oral bisphosphonate treatment or switching to another antifracture medication in adults who complete a planned oral bisphosphonate regimen but continue to receive GC treatment. Recommendations for special populations, including children, people with organ transplants, women of childbearing potential, and people receiving very high-dose GC treatment, are also made. Conclusion: This guideline provides direction for clinicians and patients making treatment decisions. Clinicians and patients should use a shared decision-making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

AB - Objective: To develop recommendations for prevention and treatment of glucocorticoid-induced osteoporosis (GIOP). Methods: We conducted a systematic review to synthesize the evidence for the benefits and harms of GIOP prevention and treatment options. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence. We used a group consensus process to determine the final recommendations and grade their strength. The guideline addresses initial assessment and reassessment in patients beginning or continuing long-term (≥3 months) glucocorticoid (GC) treatment, as well as the relative benefits and harms of lifestyle modification and of calcium, vitamin D, bisphosphonate, raloxifene, teriparatide, and denosumab treatment in the general adult population receiving long-term GC treatment, as well as in special populations of long-term GC users. Results: Because of limited evidence regarding the benefits and harms of interventions in GC users, most recommendations in this guideline are conditional (uncertain balance between benefits and harms). Recommendations include treating only with calcium and vitamin D in adults at low fracture risk, treating with calcium and vitamin D plus an additional osteoporosis medication (oral bisphosphonate preferred) in adults at moderate-to-high fracture risk, continuing calcium plus vitamin D but switching from an oral bisphosphonate to another antifracture medication in adults in whom oral bisphosphonate treatment is not appropriate, and continuing oral bisphosphonate treatment or switching to another antifracture medication in adults who complete a planned oral bisphosphonate regimen but continue to receive GC treatment. Recommendations for special populations, including children, people with organ transplants, women of childbearing potential, and people receiving very high-dose GC treatment, are also made. Conclusion: This guideline provides direction for clinicians and patients making treatment decisions. Clinicians and patients should use a shared decision-making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

UR - http://www.scopus.com/inward/record.url?scp=85025825280&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85025825280&partnerID=8YFLogxK

U2 - 10.1002/acr.23279

DO - 10.1002/acr.23279

M3 - Article

VL - 69

SP - 1095

EP - 1110

JO - Arthritis Care and Research

T2 - Arthritis Care and Research

JF - Arthritis Care and Research

SN - 2151-464X

IS - 8

ER -