Comparison of different intervention thresholds for the treatment of glucocorticoid-induced osteoporosis: a cross-sectional study
Abstract Background Glucocorticoid-induced osteoporosis (GIO) is the most common drug-induced osteoporosis. Early detection and treatment may decrease the fragility fractures. Several GIO guidelines exist, although they vary in recommended intervention thresholds for initiating pharmacologic treatme...
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2025-04-01
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| Series: | BMC Rheumatology |
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| Online Access: | https://doi.org/10.1186/s41927-025-00488-w |
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| author | Kanchalee Puksun Chatlert Pongchaiyakul Rattapol Pakchotanon Pongthorn Narongroeknawin Pornsawan Leosuthamas Thunyawarin Arunthanachaikul Sumapa Chaiamnuay |
| author_facet | Kanchalee Puksun Chatlert Pongchaiyakul Rattapol Pakchotanon Pongthorn Narongroeknawin Pornsawan Leosuthamas Thunyawarin Arunthanachaikul Sumapa Chaiamnuay |
| author_sort | Kanchalee Puksun |
| collection | DOAJ |
| description | Abstract Background Glucocorticoid-induced osteoporosis (GIO) is the most common drug-induced osteoporosis. Early detection and treatment may decrease the fragility fractures. Several GIO guidelines exist, although they vary in recommended intervention thresholds for initiating pharmacologic treatment. This study aimed to evaluate the performance of intervention thresholds in treating GIO under various guidelines. Methods Rheumatic disease patients receiving ≥ 2.5 mg/day prednisolone or equivalent for longer than 3 months between January 2013 and 2023 were retrospectively reviewed. Patients who were previously treated with anti-osteoporotic medications or had other secondary causes of osteoporosis were excluded. Bone mineral density (BMD) and Thailand-specific FRAX with glucocorticoid adjustment (GC-FRAX) were recorded. The performances of different intervention thresholds from six GIO guidelines (ACR 2022, Belgian 2022, TOPF 2021, Korean 2018, Malaysian 2015, and Japanese 2023) were examined against the incidence of actual fragility fractures. Results This study included 226 rheumatic patients, with a mean (SD) age of 62.9 (10.1) years. Most of the patients were female (88.9%). The average (SD) daily dose, cumulative dose, and duration of glucocorticoid use were 4.6 (10.6) mg/day, 9,223.4 (9,223.4) mg, and 58.3 (55.8) months, respectively. Diagnoses included rheumatoid arthritis (59.8%), systemic lupus erythematosus (22%), inflammatory myositis (4.7%), systemic sclerosis (4.7%), and others. The prevalence of major osteoporotic fractures and hip fractures was 14.2% and 0.9%, respectively. The ten-year probabilities of major osteoporotic and hip fractures (FRAX) with and without BMD were 12.6 ± 9.1, 5.4 ± 6, 10.7 ± 7.2, and 4.6 ± 4.8, respectively. The mean (SD) ten-year FRAX probabilities of major osteoporotic and hip fractures were 12.6% (9.1) and 5.4% (6) with the inclusion of BMD result, and 10.7% (7.2) and 4.6% (4.8) without the inclusion of the BMD result. The sensitivity, specificity and accuracy of the ACR 2022, Belgian 2022, TOPF 2021, Korean 2018, Malaysian 2015, and Japanese 2023 guidelines were 100%/ 3.1%/ 16.8%, 93.8%/ 14.4%/ 25.7%, 93.8%/ 43.8%/ 50.9%, 100%/ 17.5%/ 29.2%, 78.1%/ 62.9%/ 65% and 100%/ 24.2%/ 35%, respectively. Conclusions Among evaluated guidelines, ACR 2022, Korean 2018, and Japan 2023 had the highest sensitivity for GIO treatment, while Malaysian 2015 showed the highest specificity and accuracy. These findings can improve clinical decision-making in GIO management for rheumatic disease patients. |
| format | Article |
| id | doaj-art-acddd33e56c04cbb90ce7f848476128c |
| institution | OA Journals |
| issn | 2520-1026 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
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| series | BMC Rheumatology |
| spelling | doaj-art-acddd33e56c04cbb90ce7f848476128c2025-08-20T01:54:22ZengBMCBMC Rheumatology2520-10262025-04-01911910.1186/s41927-025-00488-wComparison of different intervention thresholds for the treatment of glucocorticoid-induced osteoporosis: a cross-sectional studyKanchalee Puksun0Chatlert Pongchaiyakul1Rattapol Pakchotanon2Pongthorn Narongroeknawin3Pornsawan Leosuthamas4Thunyawarin Arunthanachaikul5Sumapa Chaiamnuay6Rheumatic Disease Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of MedicineDivision of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen UniversityRheumatic Disease Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of MedicineRheumatic Disease Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of MedicineRheumatic Disease Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of MedicineRheumatic Disease Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of MedicineRheumatic Disease Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of MedicineAbstract Background Glucocorticoid-induced osteoporosis (GIO) is the most common drug-induced osteoporosis. Early detection and treatment may decrease the fragility fractures. Several GIO guidelines exist, although they vary in recommended intervention thresholds for initiating pharmacologic treatment. This study aimed to evaluate the performance of intervention thresholds in treating GIO under various guidelines. Methods Rheumatic disease patients receiving ≥ 2.5 mg/day prednisolone or equivalent for longer than 3 months between January 2013 and 2023 were retrospectively reviewed. Patients who were previously treated with anti-osteoporotic medications or had other secondary causes of osteoporosis were excluded. Bone mineral density (BMD) and Thailand-specific FRAX with glucocorticoid adjustment (GC-FRAX) were recorded. The performances of different intervention thresholds from six GIO guidelines (ACR 2022, Belgian 2022, TOPF 2021, Korean 2018, Malaysian 2015, and Japanese 2023) were examined against the incidence of actual fragility fractures. Results This study included 226 rheumatic patients, with a mean (SD) age of 62.9 (10.1) years. Most of the patients were female (88.9%). The average (SD) daily dose, cumulative dose, and duration of glucocorticoid use were 4.6 (10.6) mg/day, 9,223.4 (9,223.4) mg, and 58.3 (55.8) months, respectively. Diagnoses included rheumatoid arthritis (59.8%), systemic lupus erythematosus (22%), inflammatory myositis (4.7%), systemic sclerosis (4.7%), and others. The prevalence of major osteoporotic fractures and hip fractures was 14.2% and 0.9%, respectively. The ten-year probabilities of major osteoporotic and hip fractures (FRAX) with and without BMD were 12.6 ± 9.1, 5.4 ± 6, 10.7 ± 7.2, and 4.6 ± 4.8, respectively. The mean (SD) ten-year FRAX probabilities of major osteoporotic and hip fractures were 12.6% (9.1) and 5.4% (6) with the inclusion of BMD result, and 10.7% (7.2) and 4.6% (4.8) without the inclusion of the BMD result. The sensitivity, specificity and accuracy of the ACR 2022, Belgian 2022, TOPF 2021, Korean 2018, Malaysian 2015, and Japanese 2023 guidelines were 100%/ 3.1%/ 16.8%, 93.8%/ 14.4%/ 25.7%, 93.8%/ 43.8%/ 50.9%, 100%/ 17.5%/ 29.2%, 78.1%/ 62.9%/ 65% and 100%/ 24.2%/ 35%, respectively. Conclusions Among evaluated guidelines, ACR 2022, Korean 2018, and Japan 2023 had the highest sensitivity for GIO treatment, while Malaysian 2015 showed the highest specificity and accuracy. These findings can improve clinical decision-making in GIO management for rheumatic disease patients.https://doi.org/10.1186/s41927-025-00488-wGlucocorticoid-induced osteoporosisOsteoporosisRheumatic diseaseSystemic autoimmune diseaseFRAX scoreGlucocorticoid |
| spellingShingle | Kanchalee Puksun Chatlert Pongchaiyakul Rattapol Pakchotanon Pongthorn Narongroeknawin Pornsawan Leosuthamas Thunyawarin Arunthanachaikul Sumapa Chaiamnuay Comparison of different intervention thresholds for the treatment of glucocorticoid-induced osteoporosis: a cross-sectional study BMC Rheumatology Glucocorticoid-induced osteoporosis Osteoporosis Rheumatic disease Systemic autoimmune disease FRAX score Glucocorticoid |
| title | Comparison of different intervention thresholds for the treatment of glucocorticoid-induced osteoporosis: a cross-sectional study |
| title_full | Comparison of different intervention thresholds for the treatment of glucocorticoid-induced osteoporosis: a cross-sectional study |
| title_fullStr | Comparison of different intervention thresholds for the treatment of glucocorticoid-induced osteoporosis: a cross-sectional study |
| title_full_unstemmed | Comparison of different intervention thresholds for the treatment of glucocorticoid-induced osteoporosis: a cross-sectional study |
| title_short | Comparison of different intervention thresholds for the treatment of glucocorticoid-induced osteoporosis: a cross-sectional study |
| title_sort | comparison of different intervention thresholds for the treatment of glucocorticoid induced osteoporosis a cross sectional study |
| topic | Glucocorticoid-induced osteoporosis Osteoporosis Rheumatic disease Systemic autoimmune disease FRAX score Glucocorticoid |
| url | https://doi.org/10.1186/s41927-025-00488-w |
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