New actions of rank ligand

increased fracture risk occur early after therapy is initiated, emphasising the importance of primary prevention of fracture in high-risk individuals. Most currently available guidelines for the management of GIO were developed prior to the release of FRAX® and other risk assessment tools and the approval of newer pharmacological interventions for its management. The need for updated guidelines for Europe and other parts of the world was recognised by the International Osteoporosis Foundation (IOF) and the European Calcified Tissue Society (ECTS), which set up a joint Guideline Working Group at the end of 2010. The aim of this group was to provide a framework for the development of guidelines from which countryspecific recommendations could be derived. The framework covers the management of GIO in men and women aged 18 years or over, in whom continuous oral glucocorticoid therapy at any dose is considered for 3 months or longer. All interventions approved for GIO worldwide are included. The guidelines recommend the use of FRAX for risk assessment, with adjustment for the dose of glucocorticoid. Bone protective therapy should be started at the onset of glucocorticoid therapy in individuals at increased risk of fracture, for example postmenopausal women and older men with a previous history of fracture, women and men aged ≥70 years, and postmenopausal women and men aged ≥50 years taking high doses of glucocorticoids. A BMD T-score of ≤−1.5 in postmenopausal women and older men may also be considered as an indication for bone protective therapy. The fracture probability at which pharmacological intervention is advised varies between countries depending on local factors such as reimbursement policies, health economics, willingness to pay and availability of dual-energy X-ray absorptiometry (DXA). This article is part of a Special Issue entitled ECTS 2012. Disclosure of interest: None declared.