FRIDAY, Sept. 30, 2022 (HealthDay News) — In a summary of an updated clinical practice guideline issued by the American College of Rheumatology, recommendations are presented for the pharmacologic treatment of glucocorticoid-induced osteoporosis, with the importance of sequential treatment emphasized.

Researchers conducted a systematic literature review for clinical questions on nonpharmacologic and pharmacologic treatment of glucocorticoid-induced osteoporosis that were addressed in the 2017 guideline, and for questions about new treatments and discontinuation of medications as well as sequential and combination therapies.

The updated guideline includes recommendations on the use of abaloparatide and romosozumab, which are now available. Sequential therapy is addressed; after initiating a course of denosumab, teriparatide, abaloparatide, or romosozumab, patients will need additional therapy after discontinuation of these drugs. For example, after completion of a course of denosumab, patients should transition to one to two years of a bisphosphonate, or transition to teriparatide, abaloparatide, or romosozumab, depending on the clinical scenario. Cessation of denosumab without transition to another therapy may result in bone loss and development of new vertebral compression fractures. For anyone receiving long-term glucocorticoids who is at high risk for fracture, a strong recommendation is made for oral bisphosphonates.

“Some physicians may be surprised about the need for sequential therapy when completing a course of denosumab, parathyroid hormone/parathyroid hormone related protein, or romosozumab,” Linda Russell, M.D., from the Hospital for Special Surgery in New York City and coprincipal investigator of the guideline, said in a statement.

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