WESTPORT, CT (Reuters Health) Jul 25 - Bisphosphonates should be a first-line therapy for patients beginning short-term (3-month) glucocorticoid treatment, according to new guidelines from the American College of Rheumatology. The guidelines appear in the July issue of Arthritis and Rheumatism.
A committee headed by Dr. Lenore Buckley, from the Medical College of Virginia in Richmond, recommends that in addition, such patients should modify any lifestyle factors associated with osteoporosis and receive supplementation with calcium and vitamin D at a dosage of 800 IU/day, or an activated form of vitamin D (e.g., alfacalcidiol at 1 µg/day or calcitriol at 0.5 µg/day).
For patients receiving long-term glucocorticoid treatment, in addition to the above recommendations, the committee recommends replacement of gonadal sex hormones if needed, measurement of bone mineral density annually or biannually as needed, and bisphosphonate therapy if needed.
The committee notes that premenopausal women receiving bisphosphonates should be counseled about appropriate contraception, and calcitonin should be prescribed as a second-line agent for patients who have contraindications to bisphosphonate therapy or do not tolerate it.
"The therapies to prevent or treat glucocorticoid-induced bone loss should be continued as long as the patient is receiving glucocorticoids," Dr. Buckley and her colleagues advise.
Arthritis Rheum 2001;44:1496-1503.