{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:19:47Z","timestamp":1789579187587,"version":"build-2803163510"},"reference-count":63,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2024,11,18]],"date-time":"2024-11-18T00:00:00Z","timestamp":1731888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,11,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>This report presents the recommendations of the European Calcified Tissue Society (ECTS) for the prevention and treatment of glucocorticoid-induced osteoporosis (GIOP) in adults. Our starting point was that the recommendations be evidence based, focused on non-bone specialists who treat patients with glucocorticoid (GC) and broadly supported by ECTS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The recommendations were developed by global experts. After a comprehensive review of the literature, 25 recommendations were formulated, based on quality evidence. For stratifying fracture risk and the most appropriate first line of treatment, we have classified patients into 3 categories: those at medium risk of fractures, ie, adults without a recent (in the last 2 years) history of fracture; those at high risk of fractures, ie, adults with recent history of fracture, and\/or at least one vertebral fracture (grade \u2265 2 according to Genant classification); and those at very high risk of fractures, ie, adults aged \u226570 years with a recent hip fracture, pelvis fracture, and\/or at least one vertebral fracture (grade \u2265 2 according to Genant classification). The subtopics in the recommendations include who to assess, how to assess, who to treat, how to treat, and follow-up and monitoring.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>General measures are recommended for all patients who are being prescribed GCs for \u22653 months, ie, calcium and protein intake should be normalized, a 25(OH) vitamin D concentration of 50-125\u2005nmol\/L should be attained, and the risk of falls be minimized. (1) Who to assess? (R1-2) A preliminary assessment of fracture risk should be routinely performed in patients likely to receive oral GCs for \u22653 months: (i) women and men \u2265 50 years and (ii) patients at increased risk of fracture (history of fragility fracture and\/or have comorbidities or are on medications that are frequently associated with osteoporosis. (2) How to assess (fracture risk)? (R3-6) Clinical risk factors include history of fragility fracture, systematic vertebral imaging, and GC dose-adjusted FRAX, measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), fall risk, and biochemical testing. (3) Who to treat? (R7-12) Anti-osteoporosis treatment is indicated for women and men \u2265 50 years with (i) the presence of a recent history of vertebral and\/or non-vertebral fracture (less than 2 years), (ii) and\/or a GC dosage \u2265 7.5\u2005mg\/day, (iii) and\/or age \u2265 70 years, (iv) and\/or a T-score \u2264 \u22121.5, (v) and\/or 10-year probability risk above the country specific GC dose-adjusted FRAX\u00ae thresholds. In premenopausal women and men &amp;lt; 50 years with a Z-score \u2264 \u22122 and\/or a history of fragility fracture, it is recommended to refer the patient to a bone specialist. (4) How to treat? (R13-18) In women and men \u2265 50 years, (i) alendronate or risedronate is preferred as the first line of treatment in patients at medium risk of fractures, (ii) zoledronic acid or denosumab in patients at high risk of fractures, and (iii) teriparatide in patients at very high risk of fractures. It is imperative that sequential therapy be implemented in individuals receiving denosumab or teriparatide as their first-line treatment regimen. (5) Follow-up and monitoring (R19-25): in patients receiving anti-osteoporosis treatment, monitoring of clinical risk factors (eg, history of fragility fracture), systematic vertebral imaging, fall risk, BMD measurement using DXA, and biochemical testing should be performed regularly during follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The new, evidence-based recommendations by the ECTS for the prevention and treatment of GIOP provide clear and pragmatic advice to all health practitioners especially those who are not bone specialists.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejendo\/lvae146","type":"journal-article","created":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T07:50:34Z","timestamp":1731570634000},"page":"G1-G17","source":"Crossref","is-referenced-by-count":46,"title":["Prevention and treatment of glucocorticoid-induced osteoporosis in adults: recommendations from the European Calcified Tissue Society"],"prefix":"10.1093","volume":"191","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6599-8623","authenticated-orcid":false,"given":"Julien","family":"Paccou","sequence":"first","affiliation":[{"name":"Department of Rheumatology, University of Lille, CHU Lille, MABlab ULR 4490 , Lille F-59000 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria P","family":"Yavropoulou","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens , Athens 11527 ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anda Mihaela","family":"Naciu","sequence":"additional","affiliation":[{"name":"Unit of Endocrinology and Diabetes, Campus Bio-Medico University , Rome 00128 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manju","family":"Chandran","sequence":"additional","affiliation":[{"name":"Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital , 169608 Singapore ,","place":["Singapore"]},{"name":"DUKE NUS Medical School , 169608 Singapore ,","place":["Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osvaldo D","family":"Messina","sequence":"additional","affiliation":[{"name":"Investigaciones Reumatol\u00f3gicas y Osteol\u00f3gicas (IRO) Medical Center , Cosme Argerich Hospital, Buenos Aires 1114 ,","place":["Argentina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1058-1307","authenticated-orcid":false,"given":"Tim","family":"Rolvien","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf , Hamburg 20246 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John J","family":"Carey","sequence":"additional","affiliation":[{"name":"Department of Rheumatic Diseases, Clinical Sciences Institute, National University of Ireland Galway, 1007, Galway H91 V4AY, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella","family":"D\u2019oronzo","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro , Bari 70124 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanasios D","family":"Anastasilakis","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, 424 Military General Hospital , Thessaloniki 56429 ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth G","family":"Saag","sequence":"additional","affiliation":[{"name":"Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham , Birmingham, AL 35294 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willem F","family":"Lems","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Amsterdam University Medical Center , Amsterdam 1081HV ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,11,18]]},"reference":[{"issue":"1","key":"2024121018031736300_lvae146-B1","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1056\/NEJMcp1012926","article-title":"Clinical practice. 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