Although Dr. Saag was a coauthor of the ACR guidelines, he disagreed with this particular one in light of his own clinical trial findings as well as evidence that BMD loss and fracture risk increase early on after starting steroids, and at lower doses than previously thought problematic. So he was pleased to see a new commentary on the ACR guidelines published by the Professional Practice Committee of the ASBMR. The review recommends teriparatide or any of the bisphosphonates for high-risk patients, period.
Dr. Saag, who wasn’t involved in the ASBMR review, recommended it as useful reading both for its areas of agreement with the ACR guidelines as well as for raising several patient scenarios in which the ASBMR committee believes the ACR recommendations either don’t apply or might be improved upon.
The ASBMR commentary also lays out a research agenda, identifying key areas for future study. For example, what’s the best management strategy in lupus patients and others who may need to be on systemic steroids for a decade or more, given that teriparatide is only FDA approved for 2 years of daily use and the clinical trials of bisphosphonates for GIOPS were only 1 or 2 years long (J. Bone Miner. Res. 2011;26:1989-96).
Dr. Glüer declared having no financial conflicts regarding the Eli Lilly-funded EuroGIOPs trial. Dr. Saag disclosed that he has received research grants from and serves as a paid consultant to Amgen, Eli Lilly, Merck, and Novartis.