Guidelines for intermittent pulses of IV Glucocorticoids
Are there any guidelines for patients on intermittent pulses of IV GCs? How about inhaled steroids?
Therapeutic guidelines for prevention and treatment of GIOP in patients receiving intermittent pulse GCs without daily therapy are lacking. Patients receiving four or more monthly IV pulses (1 g methylprednisolone equivalent) or four or more high-dose oral pulses (prednisone ≥60 mg/day with taper over 2–4 weeks) within a 12-month period are at risk and should be treated based on the risk stratification outlined earlier. Patients on daily inhaled steroids (equivalent or higher dose than Advair 200 μg/day) for a prolonged period of time (20 years) can lose bone (one T-score = 12% bone loss) and should be periodically monitored.