Low-risk (10-year fracture risk < 10%)
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• GC dose < 7.5 mg/day of prednisone or equivalent:
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→ no pharmacologic treatment
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• GC dose ≥ 7.5 mg/day of prednisone or equivalent:
|
→ alendronate, risedronate or zoledronic acid
|
Medium-risk (10-year fracture risk = 10-20%)
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• GC dose < 7.5 mg/day of prednisone or equivalent:
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→ alendronate or risedronate
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• GC dose ≥ 7.5 mg/day of prednisone or equivalent:
|
→ alendronate, risedronate or zoledronic acid
|
High-risk (10-year fracture risk > 20%)
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• Any dose or duration of GCs justifies initiating prescription therapy
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▪ If GC dose < 5 mg/day of prednisone or equivalent for ≤ 1 month:
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→ alendronate, risedronate, or zoledronic acid
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▪ If GC dose ≥ 5 mg/day of prednisone or equivalent for ≤ 1 month or any GC dose for > 1 month:
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→ alendronate, risedronate, zoledronic acid or teriparatide†
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Premenopausal women and men < 50 years with a history of fragility fracture
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GC duration: 1–3 months
| |
Non-childbearing potential:
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• If prednisone (or equivalent) ≥ 5 mg/day: alendronate or risedronate
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• If prednisone (or equivalent) ≥ 7.5 mg/day: zoledronic acid
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Childbearing potential:
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• No consensus
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GC duration: >3 months
| |
Non-childbearing potential:
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• Any dose: alendronate, risedronate, zoledronic acid, teriparatide
|
Childbearing potential:
|
• If prednisone (or equivalent) < 7.5 mg/day: no consensus
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• If prednisone (or equivalent) ≥ 7.5 mg/day: alendronate, risedronate, teriparatide†
|