ECTS Abstracts (2015) 1 P371

Guidelines on the management and treatment of glucocorticoid (GC)-induced osteoporosis (GIO): from the Japanese Society for Bone and Mineral Research (JSBMR)

Yoshiya Tanaka, Yasuo Suzuki, Satoshi Soen, Saeko Fujiwara, Hisanori Nakayama, Ikuko Tanaka, Keiichi Ozono, Akira Sagawa, Ryoichi Takayanagi, Hiroyuki Tanaka, Takami Miki & Hajime Nawata


Committee for the Revision of Guideline on the Management and Treatment of Glucocorticoid-induced Osteoporosis of the Japanese Society for Bone and Mineral Research, Kyoto, Japan.


Glucocorticoid (GC)-induced osteoporosis (GIO) is the most common secondary osteoporosis and fractures occur in 30 to 50% of patients receiving GC therapy. Although it is important to prevent bone loss and fragility fracture by the early intervention, adherence to guidelines on the management of GIO is about 20% in Japan. We, therefore, revised the guideline based on accumulated references and collected data from 5 Japanese cohorts of GIO. By the analysis of 903 patients from 3 cohorts, age, GC dose, lumbar BMD and prior fragility fracture were identified as factors that predicted future fractures. When the hazard ratio for age was calculated versus <50 years, the fracture risk was 1.446 times higher at age 50< <65 and 2.108 times higher at age ≧65. Similarly, hazard ratio of fracture risk was as follows; GC dose 5< <7.5: 1.149, >7.5: 2.166 vs. < 5 mg/day; %YAM of lumber BMD 70< <80: 1.373, <70: 1.863 vs. >80; with prior fragility fracture: 3.485 vs. w/o it; with bisphosphonate 0.481 vs. w/o it. The parameter estimates for each risk factor were converted to tentative scores by the formula. The optimal cut-off score for setting the intervention threshold was validated by the data of 144 patients from 2 cohorts on primary prevention and determined by the careful discussion in the committee. It covers patients >18 years who use or are planning to use GC for >3 months and the intervention is based on achievement of a total score of >3 from each score in 4 domains: prior fragility yes: 7, age 50< <65: 2 and >65: 4, GC 5< <7.5: 1 and >7.5: 4, %YAM of lumber BMD 70< <80: 2 and <70: 4. Thus, it will aid the physician in easy and adequate decision-making for initiation of intervention to prevent fragility fracture due to GIO.

Disclosure: Y. Tanaka, has received consulting fees, speaking fees, and/or honoraria from Abbvie, Chugai, Astellas, Takeda, Santen, Mitsubishi-Tanabe, Pfizer, Janssen, Eisai, Daiichi-Sankyo, UCB, GlaxoSmithKline, Bristol-Myers and has received research grants from Mitsubishi-Tanabe, Chugai, MSD, Astellas, Novartis.