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Official Positions for FRAX(®) clinical regarding glucocorticoids: the impact of the use of glucocorticoids on the estimate by FRAX(®) of the 10 year risk of fracture from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX(®).
Journal of Clinical Densitometry
FRAX(®) Position Development Conference Members
Hans DB., Cooper C., Baim S., Dawson-Hughes B., Kanis JA., Leslie WD., Luckey MM., Rizzoli R., Poiana C., Bilezekian JP., Papapoulos SE., McCloskey EV., Binkley N., Adachi JD., Baim S., Blank RD., Boonen S., Broy SB., Bruyere O., Chandran M., Cooper C., Dawson-Hughes B., Eastell R., Ensrud K., Dimai HP., Foldes J., Garnero P., Geusen PP., Griesmacher A., Hannan MT., Kanis JA., Kleerekoper M., Krieg MA., Langdahl B., Laster A., Leib ES., Masud T., McClung M., Morris H., Ortolani S., Saag KG., Siris E., Silverman S., Bobo Tanner S., Trenti T., Vasikaran S., Vestergaard P., Wahl DA., Michael Lewiecki E., Compston JE., Adachi JD., Adams JE., Adler RA., Bauer DC., Blake GM., Clark P., Diez-Perez A., Hans DB., Josse RG., Kanis JA., Kendler DL., Khan AA., Krieg MA., Leslie WD., Lorenc RR., Moayyeri A., Masri BK., Miller PD., Cauley JA., Fuleihan el-HG., Arabi A., Calderon A., Chen Z., Chionh SB., Curtis J., Danielson ME., Fujiwara S., Hanley D., Kroger H., Kung A., Lesnyak O., Looker A., Luckey MM., Mellstrom D., Nieves J., Pluskiewicz W., Rassi RE., Rizzoli R., Ragi-Eis S., Silverman S., Schott-Pethelaz A., Bilezekian JP., Papapoulos SE., Adachi JD., Blank RD., Chapurlat R., Chih-Hsing W., Czerwinski E., Perez AD., Dimai HP., Fuleihan el-HG., Fujiwara S., Ionescu RM., Kanis JA., McClung M., Stepan J., Ragi-Eis S., Saag KG., Schousboe JT., Yu W., Zerbini C., Brown PD., McKenney P., Johansson H., Nagy J., Oden A., Wahl DA.
Publication types: Consensus Development Conference ; Journal Article
Publication Status: ppublish
Publication Status: ppublish
Given the significant impact the use of glucocorticoids can have on fracture risk independent of bone density, their use has been incorporated as one of the clinical risk factors for calculating the 10-year fracture risk in the World Health Organization's Fracture Risk Assessment Tool (FRAX(®)). Like the other clinical risk factors, the use of glucocorticoids is included as a dichotomous variable with use of steroids defined as past or present exposure of 3 months or more of use of a daily dose of 5 mg or more of prednisolone or equivalent. The purpose of this report is to give clinicians guidance on adjustments which should be made to the 10-year risk based on the dose, duration of use and mode of delivery of glucocorticoids preparations. A subcommittee of the International Society for Clinical Densitometry and International Osteoporosis Foundation joint Position Development Conference presented its findings to an expert panel and the following recommendations were selected. 1) There is a dose relationship between glucocorticoid use of greater than 3 months and fracture risk. The average dose exposure captured within FRAX(®) is likely to be a prednisone dose of 2.5-7.5 mg/day or its equivalent. Fracture probability is under-estimated when prednisone dose is greater than 7.5 mg/day and is over-estimated when the prednisone dose is less than 2.5 mg/day. 2) Frequent intermittent use of higher doses of glucocorticoids increases fracture risk. Because of the variability in dose and dosing schedule, quantification of this risk is not possible. 3) High dose inhaled glucocorticoids may be a risk factor for fracture. FRAX(®) may underestimate fracture probability in users of high dose inhaled glucocorticoids. 4) Appropriate glucocorticoid replacement in individuals with adrenal insufficiency has not been found to increase fracture risk. In such patients, use of glucocorticoids should not be included in FRAX(®) calculations.
Administration, Oral, Algorithms, Diagnosis, Computer-Assisted, Fractures, Bone/chemically induced, Glucocorticoids/administration & dosage, Glucocorticoids/adverse effects, Humans, Models, Statistical, Osteoporosis/chemically induced, Osteoporotic Fractures/chemically induced, Prednisolone/adverse effects, Risk Assessment, Risk Factors
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