Counsel a family given a new diagnosis of glucocorticoid-induced osteoporosis — OSCE

Communication framework

Establish what the parents already understand and fear. Ask the parents to recount what they have been told about the fracture and what they have read about the steroids, and acknowledge their fear directly. The worry that the prednisolone caused the fracture and the temptation to stop the steroids are the two you will spend the most time on, and you address them with the reassurance that the steroids are protecting the muscle and the heart and must not be stopped, and that the bone can be treated alongside the muscle. Do not correct them before you have heard them. ^{[3] [1]}

Explain the diagnosis in plain language. Your son's back pain comes from a small fracture in one of the bones of his spine, which we found on the side-view X-ray. We call this a vertebral compression fracture, and it happened because his bones have become thinner and more fragile than they should be for his age. This is called osteoporosis, and in children it means the combination of fragile bones and a fracture. In your son it has happened for two reasons working together: the prednisolone that is protecting his muscle can thin the bones over time, and because he is moving less, his bones are not getting the weight-bearing they need to stay strong. ^{[1] [3]}

Address the steroid fear directly. The prednisolone did play a part in thinning the bones, and I will not pretend it did not — but it is also the medicine that is keeping your son walking and protecting his heart, and stopping it suddenly would be dangerous and would not fix the bone. So we do not stop the steroids. Instead, we treat the bone with a medicine that strengthens it, and we make sure he has enough calcium and vitamin D, and we keep him as active and weight-bearing as he safely can be. The two treatments work side by side. ^{[3] [4]}