Glucocorticoids are a standard first line treatment for immune thrombocytopenia (ITP) and are an important risk factor for osteoporosis. Glucocorticoids act directly to suppress bone formation by inhibiting osteoblast function and triggering osteoblast (and osteocyte) apoptosis. They also act indirectly by inhibiting intestinal calcium absorption and reducing gonadal hormones. Despite this, current ITP guidelines (Provan et al, 2010; Neunert et al, 2011) have not addressed the need to identify patients at high risk of fragility fracture, who would benefit from bone‐protective treatment. However, recent guidelines for the prevention and treatment of osteoporosis give recommendations for patients receiving glucocorticoids, irrespective of the underlying diagnosis (Buckley et al, 2017; Compston et al, 2017) and have been based on systematic review of the literature. In this Good Practice Paper, we conduct a systematic review of the literature on osteoporosis in patients with ITP receiving glucocorticoids, assess the applicability of current guidelines on the prevention of glucocorticoid‐induced osteoporosis (GIOP) to the treatment regimens used for patients with ITP and make treatment recommendations.
Declaration of Interests
The BSH paid the expenses incurred during the writing of this guidance. None of the authors had conflicts of interest to declare. All authors have made a declaration of interests to the BSH and Task Force Chairs which may be viewed on request.