Prevention and treatment of glucocorticoid-induced osteoporosis in International and Italian scenarios

Osteoporosis (OP) and increased risk of fracture (Fx) associated with chronic glucocorticoid treatment pushed panels of experts and scientific societies to produce recommendations for both prevention and treatment of glucocorticoid-induced OP (GIO). Recently the American College of Rheumatology developed and/or endorsed their updated guidelines and recommendations for the prevention and treatment of GIO. In these recommendations the use of FRAX tool, for the 10-year probability of a major osteoporotic Fx, was integrated with other clinical risk factors to define low-, medium-, and high-risk patients. Updated approaches are delineated for post-menopausal women and men >50 years, pre-menopausal women not of childbearing potential, men <50 years and pre-menopausal women of childbearing potential with a history of a fragility Fx. Alendronate, risedronate, and zoledronic acid are the first-line choice in the majority of patients, with teriparatide as a second-line option. Concerning Italian scenarios, alendronate and risedronate are therapeutic agents currently dispensed and fully paid by the Public Health Service for the prevention and treatment of GIO in all patients >50 years, receiving >5 mg/day prednisone equivalent for >3 months; more recently teriparatide has also been included, only for those patients presenting ≥1 prevalent fragility Fx and receiving >5 mg/day prednisone equivalent for >12 months. Also zoledronic acid has been approved by Italian Agency of the Drug (AIFA, 30/08/10) for “… post-menopausal women and men chronically treated with GC ad high risk of Fx”, but the drug is dispensed exclusively at the hospital.