[Glucocorticoid and bone]

Oral glucocorticoids are prescribed for a wide variety of medical disorders. Reduced bone formation is the key process in glucocorticoid-induced osteoporosis. Glucocorticoid-induced osteoporosis is characterized by relative dissociation between the BMD values and the fracture risk, which is higher than expected based on the BMD values. 2014 revised Japanese guidelines indicated that Age, GC dose, lumbar BMD, and prior fragility fractures were identified as factors predicting future fracture and each factor was scored according to the category. Since an age of 65 years or older, prednisolone dose of 7.5mg/day or more, and a history of fragility fracture are independent risk for future fractures, initiation of drug therapy can be decided more easily without evaluation of BMD by DXA when one of these risk factors exists. Alendronate and risedronate were recommended as first-line treatment and teriparatide (rDNA origin) , ibandronate, alfacalcidol and calcitriol were recommended as alternative option.