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Glucocorticoid-Induced Osteoporosis — SCE Rheumatology MCQ

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ModerateMetabolic Bone DiseaseGlucocorticoid-Induced OsteoporosisSCE Rheumatology

A 55-year-old woman on Prednisolone 15 mg daily for PMR asks about bone protection. She has no prior fractures. T-score at the lumbar spine is -1.6 and at the hip is -1.5. According to RCP/NOGG guidance on glucocorticoid-induced osteoporosis what is the recommended management?

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Correct answer: A — Start bisphosphonate therapy as she is on ≥7.5 mg Prednisolone daily

RCP/NOGG guidelines for glucocorticoid-induced osteoporosis recommend starting bone-protective treatment (bisphosphonate first-line) in patients taking ≥7.5 mg Prednisolone daily for ≥3 months, with assessment of fracture risk using FRAX (adjusted for glucocorticoid dose). The T-score threshold for treatment in GIOP is effectively lowered because glucocorticoids increase fracture risk at any given BMD. A T-score of -1.5 on ≥15 mg Prednisolone carries significant fracture risk. All patients on glucocorticoids should receive calcium and vitamin D supplementation.

Reference: NOGG 2021; RCP 2002 glucocorticoid-induced osteoporosis guidelines