Updated guideline provides recommendations | Eurek alert!


ATLANTE — The American College of Rheumatology (ACR) has published a summary of its updated guideline for Prevention and treatment of glucocorticoid-induced osteoporosis. Many patients take glucocorticoids for various inflammatory conditions, and anyone who takes glucocorticoid medications and has other risk factors for osteoporosis increases their risk of developing glucocorticoid-induced osteoporosis. New osteoporosis drugs and publications have become available since the latest ACR treatment guidelines were published in 2017.

“One of the major side effects of corticosteroid therapy is bone loss and increased risk of fractures. Fractures can cause significant morbidity and be associated with an increased risk of mortality,” said Mary Beth Humphrey, MD, PhD, Guideline Co-Principal Investigator and Acting Vice President for Research and Professor of Medicine at the Oklahoma University Health Sciences Center.” With Newly Approved Osteoporosis Drugs and a review of the relevant literature, we felt it was important to update the guideline.”

The guideline team conducted a systematic review of the updated literature for clinical questions about non-pharmacological and pharmacological treatments addressed in the 2017 guideline, and for questions about new pharmacological treatments, discontinuation drugs, sequential and combination therapy. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to assess the certainty of the evidence. A voting panel including clinicians and patients reached ≥70% consensus on the direction (for or against) and strength (strong or conditional) of the recommendations.

The guideline includes recommendations for abaloparatide and romosozumab, which are two drugs newly available since the 2017 guideline, as well as recommendations for other osteoporosis drugs.

The guideline also recommends sequential therapy (any treatment regimen in which the patient receives one treatment followed by another), which was not addressed in the previous guideline. Recommendations for sequential therapies are based in part on certain study designs, long-term follow-up studies, and new clinical trials.

“Some physicians may be surprised at the need for sequential therapy when ending treatment with denosumab, parathyroid hormone/parathyroid hormone-related protein, or romosozumab. If this is not done, patients could be at risk of rapidly developing vertebral fractures and bone loss,” said Linda Russell, MD, director of perioperative medicine, director of the Osteoporosis Bone and Metabolic Health Center for the Hospital for Special Surgery and co-investigator of the guideline.

The updated guideline also gives more flexibility on drug selection and takes patient and physician preferences into account.

“The previous guideline classified drugs for the treatment of glucocorticoid-induced osteoporosis. We felt it was important that this guideline reflect patient/physician decision-making,” said Dr. Humphrey.

A full manuscript has been submitted for peer review and is expected to be published in rheumatology journals in early 2023. The summary of guideline recommendations can be viewed in full on the RAC website.


About the American College of Rheumatology  

Founded in 1934, the American College of Rheumatology (ACR) is a nonprofit professional association committed to advancing the specialty of rheumatology that serves more than 7,700 physicians, healthcare professionals, and scientists worldwide. In doing so, RAC provides education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatology professionals are experts in the diagnosis, management and treatment of over 100 different types of arthritis and rheumatic diseases. For more information, visitwww.rheumatology.org.

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