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Suggested Guidelines for Evaluation and Treatment of Glucocorticoid-Induced Osteoporosis for the Department of Veterans Affairs
Robert A. Adler, MD;
Marc C. Hochberg, MD, MPH
Arch Intern Med. 2003;163:2619-2624.
Background Glucocorticoid-induced osteoporosis is an important disorder in the predominantly male US veteran population. Department of Veterans Affairs facilities vary considerably in evaluation and management of glucocorticoid-induced osteoporosis.
Methods We suggest how evaluation and management can take place in medical centers with and without bone mineral density measurements by dual energy x-ray absorptiometry (DXA). The proposed guidelines can be applied to other health care systems.
Results Use of DXA can help determine fracture risk for patients taking glucocorticoid therapy and for those starting therapy for at least 3 months. Patients with low bone mineral density should be treated with a bisphosponate as should all patients about to start prednisone treatment at a dose of 7.5 mg/d or more. In facilities without DXA, most patients should be treated with bisphosphonates, the cost of which is about $30 to $35 per month. In addition, the use of urinary calcium measurements is encouraged to determine which patients might benefit from augmented vitamin D and calcium supplementation.
Conclusion Attention to fracture risk assessment in patients undergoing glucocorticoid therapy and timely bisphosphonate treatment should lead to fewer fractures.
From the Endocrinology Section, McGuire Veterans Affairs Medical Center, and Departments of Internal Medicine and Preventive Medicine and Community Health, Medical College of Virginia of Virginia Commonwealth University, Richmond (Dr Adler); and Departments of Medicine and Epidemiology and Preventive Medicine, University of Maryland School of Medicine, and Department of Medicine, Maryland Veterans Affairs Health Care System, Baltimore (Dr Hochberg). Dr Adler has served on the speakers bureau of or received honoraria from Merck & Co, Procter & Gamble, and Eli Lilly Inc. Dr Hochberg has served as consultant to Aai Laboratories, Abbott Laboratories, Aventis Pharmaceutical Co Inc, Bristol Myers Squibb, Eli Lilly Inc, Genzyme Corporation, La Jolla Pharmaceutical Co, Laboratories NEGMA, Merck & Co, Novartis, Sanofi-Synthelabo, Scios Inc, and Wyeth Ayerst, and is a stock shareholder in Johnson & Johnson, Eli Lilly Inc, Merck & Co, Procter & Gamble, and Schering Plough.
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