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GIOP Treatment Threshold — RACP Adult Medicine MCQ

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EasyRheumatologyGIOP Treatment ThresholdRACP Adult Medicine

A 55-year-old woman on long-term prednisolone for SLE is being assessed for bone health. She has a T-score of -1.8 at the lumbar spine. She has been on prednisolone ≥7.5 mg daily for 4 months. What bone-protective therapy is indicated?

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Correct answer: E — Teriparatide first-line

Glucocorticoid-induced osteoporosis (GIOP) has a lower treatment threshold than postmenopausal osteoporosis because fracture risk is higher at any given T-score with glucocorticoid use. Australian and international guidelines recommend commencing anti-osteoporosis treatment (bisphosphonate first-line) for ANY patient on prednisolone ≥7.5 mg/day (or equivalent) for ≥3 months, regardless of T-score. Additional risk factors (prior fracture, age >70, very low T-score) strengthen the indication. Calcium (1000–1200 mg/day) and vitamin D (800–1000 IU/day) are mandatory adjuncts but insufficient alone.

Reference: RACGP – 2017 – Osteoporosis Guideline; eTG – 2025 – Rheumatology; ACR – 2022 – GIOP Guidelines