Primary prevention
Secondary prevention
Appropriate immunizations, including influenza and pneumococcal vaccines, should be administered. While patients are receiving >20 mg of prednisone daily, they should be given prophylaxis for Pneumocystis jirovecii pneumonia (PJP).[108] Although PJP is rare in patients with GCA, it is associated with significant morbidity and is potentially life-threatening.[109]
Long-term glucocorticoids should be accompanied with agents to prevent glucocorticoid-induced bone loss. Measures include optimized intake of dietary and supplemental calcium and vitamin D based on age-appropriate national recommended daily allowances.[68] Patients ages ≥40 years receiving long-term glucocorticoids and deemed to be at high risk of fracture should receive oral bisphosphonates. Other agents including intravenous bisphosphonates, parathyroid hormone/parathyroid hormone related protein agonists (e.g., teriparatide, abaloparatide) or denosumab are also options. Selection of an agent should be based on patient and physician preferences.[68]
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