Quiz: Fracture Risk Assessment in Patients Taking Glucocorticoids

Osteoporosis (©JavierRegueiroShutterstock.com)

How well do you know the treatment recommendations from the 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis? Test your knowledge in this quiz.

1) Approximately 1% of adults in the U.S. are treated with long-term glucocorticoid therapy for a range of medical conditions. What percentage of those will experience fractures?

a) 10%
b) 20%
c) 25%
d) 40%

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Answer:  a) 10%

“More than 10% of patients who receive long-term glucocorticoid treatment are diagnosed with a fracture, and 30–40% have radiographic evidence of vertebral fractures.”

2) True/False: Fracture risk associated with glucocorticoid treatment is cumulative and irreversible.

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Answer: False

“…glucocorticoid treatment is a potentially reversible risk factor for glucocorticoid-induced osteoporosis (GIOP); if glucocorticoid treatment is terminated, bone mineral density (BMD) increases and fracture risk declines.”

3) Which of the following factors influences risk of glucocorticoid-induced fracture?

a) Duration of use
b) Bone strength at the time of initiation of glucocorticoid treatment
c) Glucocorticoid dose
d) Osteoporosis risk factors
e)  All of the above

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Answer: e)  All of the above

“Risk factors for glucocorticoid -induced fracture include low bone strength at the beginning of GC treatment and the rate of decline in bone mass during treatment, which is largely determined by the dose and duration of glucocorticoid use.…In addition, the absolute risk of future fracture in an individual is substantially influenced by demographic and other characteristics (age, race, sex, and concomitant OP risk factors).”

4) A history of prior osteoporosis-related fracture is indicative of what level of risk for individuals being considered for glucocorticoid therapy?

a) Moderate
b) Conditional
c) Mild to Moderate
d) High

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Answer: d) High

Adults ≥ 40 and adults < 40 are all at high fracture risk if they have had a prior osteoporotic fracture.

5) Men and women under age 40 taking glucocorticoid therapy are considered to be at what level of fracture risk?

a) No risk
b) Moderate
c) Mild
d) High

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Answer: Moderate

“The Voting Panel designated men and women < 40 years of age to be at moderate risk if they were expected to continue GC glucocorticoid treatment at > 7.5 mg/day for 6 months and had either 1) a hip or spine BMD Z score of < -3 or 2) a rapid decline in hip or spine BMD (equivalent to ≥ 10% in 1 year) during GC treatment.”

6) In adults and children taking long-term glucocorticoid therapy, the ACR recommends that fracture risk assessment be performed:

a) within the first 6 months of initiating treatment
b) within the first year of initiating treatment
c) prior to initiating treatment
d) monthly

Answer: a) within the first 6 months of initiating treatment

“In all adults and children, an initial clinical fracture risk assessment should be performed as soon as possible, but at least within 6 months of the initiation of long-term glucocorticoid treatment.”

REFERENCE

Buckley L, Guyatt G, Fink HA, et al.  2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. Arthritis Care Res (Hoboken) 2017;69:1095-1110.