Prevention of Glucocorticoid-induced Osteoporosis in Elderly Patients With Immune Thrombocytopenia: a Single-institute Retrospective Study

Introduction: Prednisolone, used as a standard initial treatment for immune thrombocytopenia (ITP), is an important risk factor for osteoporosis. To investigate the prevention of glucocorticoid-induced osteoporosis (GIO) in elderly ITP patients, associations between GIO prevention and score changes of a dual-energy X-ray absorptiometry (DXA) scan, FRAX ® , and the Garvan tool during initial loading of prednisolone were examined. Methods: : In our institute, 22 ITP patients aged > 70 years received 0.5–1.0 mg/kg prednisolone for 2–3 weeks as the initial ITP treatment between 2014 and 2021. The femoral neck bone mineral density (BMD) measured by DXA scan was entered into FRAX ® to define the risk-adapted approach to bisphosphonate during the initial loading of prednisolone. Additional active vitamin D with bisphosphonate was prescribed for women. Results: : During the initial loading of prednisolone in ITP patients aged > 70 years, seven patients achieved a complete response. Fifteen patients with a platelet count <30 × 10 9 /L received thrombopoietin receptor agonist at the tapering phases of prednisolone. Bisphosphonate was performed according to <−1.0 femoral neck BMD T-score measured by DXA scan. Worse scores of FRAX ® and the Garvan tool were associated with use of bisphosphonate for short-term fracture prevention in primary GIO; however, there were no incidents of fracture and no significant differences in probabilities determined by FRAX ® and the Garvan tool. Conclusions: : During the initial loading of prednisolone, prescribing bisphosphonate might prevent the reduction of BMD, but additional prescription of active vitamin D for women is still controversial.