J Rheum Dis 2018; 25(4): 263-295  
Korean Guideline for the Prevention and Treatment of Glucocorticoid-induced Osteoporosis
So Young Park1, Hyun Sik Gong2, Kyoung Min Kim3, Dam Kim4, Hayoung Kim5, Chan Hong Jeon6, Ji Hyeon Ju7, Shin-Seok Lee8, Dong Ah Park9, Yoon-Kyoung Sung10, Sang Wan Kim11
1Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, 2Department of Orthopedic Surgery, 3Division of Endocrinology and Metabolism, Department of Internal Medicine, Bundang Hospital, Seoul National University College of Medicine, Seongnam, 4Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, 5Division of Endocrinology, Department of Internal Medicine, Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, 6Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, 7Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 8Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, 9National Evidence-based Healthcare Collaborating Agency, Seoul, 10Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 11Division of Endocrinology and Metabolism, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
Correspondence to: Yoon-Kyong Sung http://orcid.org/0000-0001-6691-8939
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea. E-mail:sungyk@hanyang.ac.kr
Sang Wan Kim http://orcid.org/0000-0001-9561-9110
Division of Endocrinology and Metabolism, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea. E-mail : swkimmd@snu.ac.kr
Received: July 27, 2018; Revised: September 1, 2018; Accepted: September 2, 2018; Published online: October 1, 2018.
© Korean College of Rheumatology. All rights reserved.

This is a open Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Objective. To develop guidelines and recommendations to prevent and treat glucocorticoid-induced osteoporosis (GIOP) in Korea. Methods. The Korean Society for Bone and Mineral Research and the Korean College of Rheumatology developed this guideline based on Guidance for the Development of Clinical Practice Guidelines version 1.0 established by the National Evidence-Based Healthcare Collaborating Agency. This guideline was developed by adapting previously-published guidelines, and a systematic review and quality assessment were conducted. Results. This guideline applies to adults aged 19 years or older who are using or plan to use glucocorticoids (GCs), but does not include children and adolescents. An initial assessment of fracture risk should be performed within 6 months of initial GC use. Fracture risk should be estimated using FRAX (Fracture Risk Assessment Tool) with adjustments for GC dose, previous osteoporotic fracture history, and bone mineral density (BMD) results. All patients taking more than 2.5 mg/day prednisolone or equivalent for more than 3 months are recommended to take adequate calcium and vitamin D. Patients at moderate to high fracture risk should be treated with additional osteoporosis medication. All patients continuing GC therapy should receive an annual BMD measurement, vertebral X-ray, and fracture risk assessment using FRAX. When a treatment failure is suspected, switching to another drug should be considered. Conclusion. This guideline is intended to provide guidance for clinicians in prevention and treatment of GIOP.
Keywords: Denosumab, Diphosphonates, Glucocorticoids, Osteporosis, Teriparatide


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