Corticosteroid-Induced Osteoporosis: Question Six
Your answer is incorrect. The correct answer is A.
This patient falls into the high risk category for glucocorticoid-induced fractures, per the 2010 ACR guidelines. You decide to start her on alendronate simultaneously with initiating glucocorticoids. How should you monitor her for changes in her bone mineral density over time?
- Option A Bone mineral density should be measured yearly until stable, then every one to three years
- Option B Bone mineral density should be measured every six months
- Option C Bone mineral density should be measured every five years
- Option D No monitoring is necessary if the patient is adherent to recommended preventative therapies
How should bone mineral density be monitored in patients taking prolonged glucocorticoids?
- The guidelines vary somewhat in their recommended frequency for BMD measurement in patients taking chronic glucocorticoids.
- Nearly all agree that BMD should be measured one year after the initiation of steroids, and yearly thereafter.
- However, some guidelines recommend decreasing the frequency of BMD measurement to every two to three years if it remains stable (1-3).
- Grossman J, Gordon R, Ranganath V, et al. American College of Rheumatology Recommendations for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. Arthritis Care and Research 2010; 62: 1515-1526. Available online.
- Watts NB, Lewiecki EM, Bonnick SL, Laster AJ, Binkley N, Blank RD, et al. Clinical value of monitoring BMD in patients treated with bisphosphonates for osteoporosis. J Bone Miner Res 2009; 24: 1643-1646.
- Bell KJ, Hayen A, Macaskill P, Irwig L, Craig JC, Ensrud K, et al. Value of routine monitoring of bone mineral density after starting bisphosphonate treatment: secondary analysis of trial data. BMJ 2009; 338: b2266.