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.