Table 11 ACR pharmacological recommendations for the prevention and management of GC-induced osteoporosis in adults*[115]

Low-risk (10-year fracture risk < 10%)

• GC dose < 7.5 mg/day of prednisone or equivalent:

   → no pharmacologic treatment

• GC dose ≥ 7.5 mg/day of prednisone or equivalent:

   → alendronate, risedronate or zoledronic acid

Medium-risk (10-year fracture risk = 10-20%)

• GC dose < 7.5 mg/day of prednisone or equivalent:

   → alendronate or risedronate

• GC dose ≥ 7.5 mg/day of prednisone or equivalent:

   → alendronate, risedronate or zoledronic acid

High-risk (10-year fracture risk > 20%)

• Any dose or duration of GCs justifies initiating prescription therapy

 ▪ If GC dose < 5 mg/day of prednisone or equivalent for ≤ 1 month:

   → alendronate, risedronate, or zoledronic acid

 ▪ If GC dose ≥ 5 mg/day of prednisone or equivalent for ≤ 1 month or any GC dose for > 1 month:

   → alendronate, risedronate, zoledronic acid or teriparatide^†

Premenopausal women and men < 50 years with a history of fragility fracture

GC duration: 1–3 months

Non-childbearing potential:

• If prednisone (or equivalent) ≥ 5 mg/day: alendronate or risedronate

• If prednisone (or equivalent) ≥ 7.5 mg/day: zoledronic acid

Childbearing potential:

• No consensus

GC duration: >3 months

Non-childbearing potential:

• Any dose: alendronate, risedronate, zoledronic acid, teriparatide

Childbearing potential:

• If prednisone (or equivalent) < 7.5 mg/day: no consensus

• If prednisone (or equivalent) ≥ 7.5 mg/day: alendronate, risedronate, teriparatide^†