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Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
Copyright © 2021 Korean Endocrine Society
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICTS OF INTEREST
Yoon-Kyoung Sung has received research grants from Bristol-Myers Squibb, Eisai, Pfizer, and JW Pharmaceutical. Soo-Kyung Cho has no conflict of interest.
Guideline | Initial fracture risk assessment | Intervention thresholds | Subject |
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SER (2019) [32] |
FRAX BMD (if FRAX 10-year risk of major osteoporotic fracture ≥5%) |
Postmenopausal women and men aged ≥50 years with GC ≥5 mg/day BMD T-score ≤−1.5 OR FRAX 10-year risk of hip fracture ≥3% OR FRAX 10-year risk of major osteoporotic fracture ≥10% without BMD OR FRAX 10-year risk of major osteoporotic fracture ≥7.5% with BMD Premenopausal women and men aged <50 years with GC ≥7.5 mg/day BMD Z-score ≤−3 |
All adults Prior fragility fracture OR Initial GC ≥30 mg/day |
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KSBMR/KCR (2018) [30] |
Adults aged ≥40 years FRAX (GC-adjusted)a BMD (within 6 months of GC initiation) |
Adults aged ≥40 years BMD T-score ≤−2.5 (postmenopausal women and men aged ≥50 years) OR FRAX 10-year risk of major osteoporotic fracture ≥10% OR FRAX 10-year risk of hip fracture >1% |
All adults Prior fragility fracture OR Very high dose GCsc (age ≥30 years) |
Adults aged <40 years BMD at high risk (within 6 months of GC initiation) |
Adults aged <40 years with GC ≥7.5 mg/day BMD Z-score <−3 OR ≥10%/year loss of BMD |
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ACR (2017) [33] |
Adults aged ≥40 years FRAX (GC-adjusted)a BMD (if available) (within 6 months of GC initiation) |
Adults aged ≥40 years BMD T-score ≤−2.5 (postmenopausal women and men aged ≥50 years) OR FRAX 10-year risk of major osteoporotic fracture ≥10% OR FRAX 10-year risk of hip fracture >1% |
All adults Prior fragility fracture OR Very high dose GCsc (age ≥30 years) |
Adults aged <40 years BMD at high risk (within 6 months of GC initiation) |
Adults aged <40 years with GC ≥7.5 mg/day BMD Z-score <−3 OR ≥10%/year loss of BMD |
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NOGG (2017) [31] |
FRAX (GC-adjusted)b BMD at intermediate risk |
Postmenopausal women and men aged ≥50 years Age ≥70 years OR GC ≥7.5 mg/day OR FRAX above intervention threshold |
All adults Prior fragility fracture |
Premenopausal women and men aged <50 years High dose GCs |
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SIOMMMS (2016) [41] | DeFRA (GC-adjusted) |
Postmenopausal women and men aged ≥50 years GC ≥5 mg/day for ≥3 months |
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SEIOMM (2015) [40] | NA |
Postmenopausal women and men aged ≥50 years GC dose ≥5 mg/day for ≥3 months |
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Premenopausal women and men aged <50 years Prior fragility fracture OR very low BMD OR very high dose GCs |
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SFR/GRIO (2014) [39] |
BMD (GC use ≥3 months) VFA (GC ≥7.5 mg/day for ≥3 months) |
Postmenopausal women and men aged ≥50 years Prior fragility fracture OR age ≥70 years OR GC ≥7.5 mg/day for ≥3 months OR BMD T-score ≤−2.5 OR FRAX (GC-adjusted)b above intervention threshold (when not applicable of above indications) |
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Premenopausal women and men aged <50 years GC use ≥3 months plus fragility fracture |
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JSBMR (2014) [42] | Score based on prior fragility fracture, age, GC dose, and lumbar spine BMD (% YAM) | Calculated individual patient’s score ≥3 | |
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IOF-ECTS (2012) [37] |
FRAX (GC-adjusted)b BMD (if available) at intermediate risk |
Postmenopausal women and men aged ≥50 years Prior fragility fracture OR age ≥70 years OR GC ≥7.5 mg/day for ≥3 months OR BMD T-score ≤−1.5 OR FRAX above intervention threshold |
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Premenopausal women and men aged <50 years GC use ≥3 months plus fragility fracture |
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SBR/BMA/ABMFR (2012) [38] | BMD |
Postmenopausal women GC ≥5 mg/day for ≥3 months |
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Men Planning to initiate GC ≥5 mg/day for ≥3 months plus T score ≤−1.0 Already using GC ≥5 mg/day for ≥3 months plus T score ≤−1.8 |
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Osteoporosis Canada (2010) [35] | BMD (GC ≥7.5 mg/day for ≥3 months) |
Adults aged >50 years GC ≥7.5 mg/day for ≥3 months |
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DVO (2009) [36] |
Women aged ≥50 years and men aged ≥60 years BMD (if GC use ≥3 months) |
GC ≥7.5 mg/day for ≥3 months and BMD T-score ≤−1.5 | |
Women aged <50 years and men aged <60 years BMD (if GC ≥7.5 mg/day for ≥3 months) |
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BBC (2006) [34] | NA | GC ≥7.5 mg/day for ≥3 months |
Adapted from Lee et al., with permission from JBM Publishing Group [43].
SER, Sociedad Española de Reumatología; FRAX, fracture risk assessment tool; BMD, bone mineral density; GC, glucocorticoid; KSBMR/KCR, Korean Society for Bone and Mineral Research/Korean College of Rheumatology; ACR, American College of Rheumatology; NOGG, National Osteoporosis Guideline Group; SIOMMMS, Società Italiana dell’Osteoporosi del Metabolismo Minerale e delle Malattie dello Scheletro; DeFRA, derived FRAX; SEIOMM, Sociedad española de investigaciones en metabolismo óseo y mineral; NA, not available; SFR/GRIO, Société Française de Rhumatologie/Groupe de Recherche et d’Information sur les Ostéoporoses; VFA, Vertebral Fracture Assessment; JSBMR, Japanese Society for Bone and Mineral Research; YAM, young adult men; IOF-ECTS, International Osteoporosis Foundation-European Calcified Tissue Society; SBR/BMA/ABMFR, Sociedade Brasileira de Reumatologia/Brazilian Medical Association/Associação Brasileira de Medicina Física e Reabilitação; DVO, Dachverband Osteologie; BBC, Belgium Bone Club.
a If GC ≥7.5 mg/day, the risk of hip fracture is increased by 20% and the risk of a major osteoporotic fracture is increased by 15%;
b If GC <2.5 mg/day, the risk of hip fracture is decreased by 35% and the risk of a major osteoporotic fracture is decreased by 20%, if GC ≥2.5 mg/day and <7.5 mg/day, no adjustment, and if GC ≥7.5 mg/day, risk of hip fracture is increased by 20% and major osteoporotic fracture is increased by 15%;
c Defined as treatment with prednisone ≥30 mg/day and a cumulative dose of >5 g in the past year.