Question 1

At what glucocorticoid dose should I start bone protection?

Accepted Answer

Any dose of prednisolone ≥2.5 mg/day for ≥3 months increases fracture risk. The ACR recommends risk assessment at initiation of ≥3 months of therapy, regardless of dose.

Question 2

Which bone-protective agent is first-line for GIOP?

Accepted Answer

Oral bisphosphonates (alendronate, risedronate) are first-line. Zoledronic acid or denosumab are alternatives if oral bisphosphonates are not tolerated.

Question 3

Should I check bone mineral density before starting prophylaxis?

Accepted Answer

BMD is recommended in adults ≥40 years at baseline and every 1–2 years during therapy. In younger adults or those with existing vertebral fracture, treatment may be started without BMD.

Question 4

How long should bone protection continue after stopping glucocorticoids?

Accepted Answer

Continue for at least 12 months after glucocorticoid discontinuation, then reassess. If the glucocorticoid course was brief (<3 months), no long-term bone protection is usually needed.