RECOMMENDATIONS
Patients beginning therapy with Prednisolone equivalent of >5 mg/day with plans for treatment duration of ≥3 months:
- Modify lifestyle risk factors for osteoporosis:
- Smoking cessation or avoidance
- Reduction of alcohol consumption if excessive
- Instruct in weight-bearing physical exercise
- Initiate calcium supplementation
- Initiate supplementation with vitamin D (plain or activated form)
- Prescribe bisphosphonate (use with caution in premenopausal women)
Patients receiving long-term glucocorticoid therapy (prednisone equivalent of >5 mg/day):
- Modify lifestyle risk factors for osteoporosis:
- Smoking cessation or avoidance
- Reduction of alcohol consumption if excessive
- Instruct in weight-bearing physical exercise
- Initiate calcium supplementation
- Initiate supplementation with vitamin D (plain or activated form)
- Prescribe treatment to replace gonadal sex hormones if deficient or otherwise clinically indicated
- Measure bone mineral density (BMD) at lumbar spine and/or hip If bone mineral density is not normal (i.e., T-score below -1), then:
- Prescribe bisphosphonate (use with caution in premenopausal women)
- Consider calcitonin as second-line agent if patient has contraindication to or does not tolerate bisphosphonate therapy
- If bone mineral density is normal, follow up and repeat bone mineral density measurement either annually or biannually