Osteoporosis Risk Management with Inhaled Corticosteroids

Patient Risk Stratification

The American College of Rheumatology recommends that oral prednisone ≥2.5 mg/day increases fracture risk significantly, and doses ≥7.5 mg/day require aggressive bone protection 1, 2, 3
Patients using Flonase or Advair with age ≥50 years, particularly postmenopausal women, are at higher risk of osteoporosis 1
Pre-existing osteoporosis or prior fragility fractures increase the risk of osteoporosis in patients using Flonase or Advair 2, 4

The American College of Rheumatology suggests obtaining detailed corticosteroid history, including all inhaled and oral formulations, doses, and duration, for patients starting or currently on Flonase/Advair 2
Assessing for falls, prior fractures, and other osteoporosis risk factors is crucial for patients on Flonase or Advair 4
Measuring height and weight, and checking for spinal tenderness or deformity, is recommended for patients on Flonase or Advair 4

The American College of Rheumatology recommends calcium supplementation of 1,000-1,200 mg daily for patients on Flonase or Advair 5
Vitamin D supplementation of 800-1,000 IU daily is recommended for patients on Flonase or Advair 5

Oral bisphosphonates, such as alendronate or risedronate, are first-line therapy for patients with moderate-to-high fracture risk on Flonase or Advair 2, 6
Intravenous bisphosphonates or denosumab are alternative treatments for patients with moderate-to-high fracture risk on Flonase or Advair 1

High-risk patients on treatment should have their bone mineral density (BMD) repeated every 2-3 years 4
Patients not on osteoporosis medication should have their FRAX and BMD reassessed every 1-3 years 4