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American College of Rheumatology Guidelines finally include Vitamin D – June 2017

2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis.

Arthritis Rheumatol. 2017 Jun 6. doi: 10.1002/art.40137. [Epub ahead of print]
Buckley L1, Guyatt G2, Fink HA3, Cannon M4, Grossman J5, Hansen KE6, Humphrey MB7, Lane NE8, Magrey M9, Miller M10, Morrison L11, Rao M12, Robinson AB13, Saha S6, Wolver S14, Bannuru RR12, Vaysbrot E12, Osani M12, Turgunbaev M15, Miller AS15, McAlindon T12.


Unfortunately they only recommend 600 IU of vitamin D, too much Calcium, and do not mention Magnesium etc needed by bones

Wonder if they fear US patients getting more vitamin D the way the Austrailian patients did 4 years years ago    20X increase in vitamin D sold and 36 percent decrease in osteoporosis business in Australia – Nov 2013

Overview Osteoporosis and vitamin D contains the following

  • FACT: Bones need Calcium (this has been known for a very long time)
  • FACT: Vitamin D improves Calcium bioavailability (3X ?)
  • FACT: Should not take > 750 mg of Calcium if taking lots of vitamin D (Calcium becomes too bio-available)
  • FACT: Adding vitamin D via Sun, UV, or supplements increased vitamin D in the blood
  • FACT: Vitamin D supplements are very low cost
  • FACT: Many trials, studies. reviews, and meta-analysis agree: adding vitamin D reduces osteoporosis
  • FACT: Toxic level of vitamin D is about 4X higher than the amount needed to reduce osteoporosis
  • FACT: Co-factors help build bones.
  • FACT: Vitamin D Receptor can restrict Vitamin D from getting to many tissues, such as bones
  • It appears that to TREAT Osteoporosis:
  •        Calcium OR vitamin D is ok
  •        Calcium + vitamin D is good
  •        Calcium + vitamin D + other co-factors is great
  •        Low-cost Vitamin D Receptor activators sometimes may be helpful
  • CONCLUSION: To PREVENT many diseases, including Osteoporosis, as well as TREAT Osteoporosis
  • Category Osteoporosis has 214 items
  • Category Bone Health has 304 items

Note: Osteoporosis causes bones to become fragile and prone to fracture
  Osteoarthritis is a disease where damage occurs to the joints at the end of the bones

Osteoporosis category includes the following

Falls and Fractures category contains the following



  • Drugs that may harm bone (vitamin D needed) -April 2016 - which contains the following
    Glucocorticoids are used to treat many medical conditions, including allergic, rheumatic, and other inflammatory diseases, and as immunosuppressive therapy after solid organ and bone marrow transplant. They are the most common cause of drug-induced bone loss and related secondary osteoporosis. Multiple effects on bone Glucocorticoids both increase bone resorption and decrease bone formation by a variety of mechanisms.1 They reduce intestinal calcium absorption, increase urinary excretion of calcium, and enhance osteocyte apoptosis, leading to deterioration of the bone microarchitecture and bone mineral density.2 They also affect sex hormones, decreasing testosterone production in men and estrogen in women, leading to increased bone resorption, altered bone architecture, and poorer bone quality.3,4 The bone loss is greater in trabecular bone (eg, the femoral neck and vertebral bodies) than in cortical bone (eg, the forearm).5

 Download the PDF from VitaminDWiki

To develop recommendations for prevention and treatment of glucocorticoid-induced osteoporosis (GIOP).

We conducted a systematic review to synthesize the evidence for the benefits and harms of GIOP prevention and treatment options. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence. We used a group consensus process to determine the final recommendations and grade their strength. The guideline addresses initial assessment and reassessment in patients beginning or continuing long-term (≥3 months) glucocorticoid (GC) treatment, as well as the relative benefits and harms of lifestyle modification and of calcium, vitamin D, bisphosphonate, raloxifene, teriparatide, and denosumab treatment in the general adult population receiving long-term GC treatment, as well as in special populations of long-term GC users.

Because of limited evidence regarding the benefits and harms of interventions in GC users, most recommendations in this guideline are conditional (uncertain balance between benefits and harms). Recommendations include treating only with calcium and vitamin D in adults at low fracture risk, treating with calcium and vitamin D plus an additional osteoporosis medication (oral bisphosphonate preferred) in adults at moderate-to-high fracture risk, continuing calcium plus vitamin D but switching from an oral bisphosphonate to another antifracture medication in adults in whom oral bisphosphonate treatment is not appropriate, and continuing oral bisphosphonate treatment or switching to another antifracture medication in adults who complete a planned oral bisphosphonate regimen but continue to receive GC treatment. Recommendations for special populations, including children, people with organ transplants, women of childbearing potential, and people receiving very high-dose GC treatment, are also made.

This guideline provides direction for clinicians and patients making treatment decisions. Clinicians and patients should use a shared decision-making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

© 2017, American College of Rheumatology. PMID: 28585373 DOI: 10.1002/art.40137

Created by admin. Last Modification: Wednesday June 7, 2017 13:51:02 GMT-0000 by admin. (Version 9)

Attached files

ID Name Comment Uploaded Size Downloads
8077 Osteo guidelines.pdf admin 07 Jun, 2017 462.06 Kb 777