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Title: Official Positions for FRAX (R) Clinical Regarding Glucocorticoids: The Impact of the Use of Glucocorticoids on the Estimate by FRAX (R) of the 10 Year Risk of Fracture
Authors: Leib, Edward S.
Saag, Kenneth G.
Adachi, Jonathan D.
Binkley, Neil
McCloskey, Eugene V.
Hans, Didier B.
Issue Date: 2011
Abstract: Given the significant impact the use of glucocorticoids can have on fracture risk independent of bone density, their use has been incorporated as one of the clinical risk factors for calculating the 10-year fracture risk in the World Health Organization's Fracture Risk Assessment Tool (FRAX (R)). Like the other clinical risk factors, the use of glucocorticoids is included as a dichotomous variable with use of steroids defined as past or present exposure of 3 months or more of use of a daily dose of 5 mg or more of prednisolone or equivalent. The purpose of this report is to give clinicians guidance on adjustments which should be made to the 10-year risk based on the dose, duration of use and mode of delivery of glucocorticoid preparations. A subcommittee of the International Society for Clinical Densitometry and International Osteoporosis Foundation joint Position Development Conference presented its findings to an expert panel and the following recommendations were selected. 1) There is a dose relationship between glucocorticoid use of greater than 3 months and fracture risk. The average dose exposure captured within FRAX (R) is likely to be a prednisone dose of 2.5-7.5 mg/day or its equivalent. Fracture probability is under-estimated when prednisone dose is greater than 7.5 mg/day and is over-estimated when the prednisone dose is less than 2.5 mg/day. 2) Frequent intermittent use of higher doses of glucocorticoids increases fracture risk. Because of the variability in dose and dosing schedule, quantification of this risk is not possible. 3) High dose inhaled glucocorticoids may be a risk factor for fracture. FRAX (R) may underestimate fracture probability in users of high dose inhaled glucocorticoids. 4) Appropriate glucocorticoid replacement in individuals with adrenal insufficiency has not been found to increase fracture risk. In such patients, use of glucocorticoids should not be included in FRAX (R) calculations.
Notes: [Leib, ES] Univ Vermont, Coll Med, Burlington, VT 05401 USA [Saag, KG] Univ Alabama, Birmingham, AL USA [Adachi, JD] McMaster Univ, St Josephs Healthcare, Hamilton, ON, Canada [Geusens, PP] Maastricht Univ Caphri, Dept Internal Med, Fac Hlth Med & Life Sci, Maastricht, Netherlands [Geusens, PP] Univ Hasselt, Biomed Res Ctr, Hasselt, Belgium [Binkley, N] Univ Wisconsin, Sch Med & Publ Hlth, Madison, WI USA [McCloskey, EV] Univ Sheffield, Sheffield, S Yorkshire, England [Hans, DB] Univ Lausanne Hosp, Dept Bone & Joint, Lausanne, Switzerland
Keywords: Glucocorticoids; fracture risk; drug-induced osteoporosis; FRAX
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ISSN: 1094-6950
e-ISSN: 1559-0747
DOI: 10.1016/j.jocd.2011.05.014
ISI #: 000293989900007
Category: A1
Type: Journal Contribution
Validations: ecoom 2012
Appears in Collections:Research publications

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