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Glucocorticoid-Induced Osteoporosis — RACP Adult Medicine MCQ

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ModerateClinical PharmacologyGlucocorticoid-Induced OsteoporosisRACP Adult Medicine

A 50-year-old woman on long-term prednisolone 15 mg daily for SLE presents for bone health assessment. Her DEXA shows a T-score of -1.8 at the lumbar spine. According to Australian guidelines, what is the threshold for commencing osteoporosis treatment in patients on long-term glucocorticoids?

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Correct answer: D — Any T-score if on prednisolone ≥7.5 mg/day for ≥3 months

The Royal Australian College of General Practitioners and RA guidelines recommend initiating osteoporosis treatment (bisphosphonate first-line) for any patient on prednisolone ≥7.5 mg/day (or equivalent) for ≥3 months, regardless of T-score. This is because glucocorticoid-induced osteoporosis has a higher fracture risk at any given T-score compared to postmenopausal osteoporosis. Calcium and vitamin D supplementation should also be provided.

Reference: RACGP – 2017 – Osteoporosis Clinical Guideline; eTG – 2025 – Rheumatology