The aim of the study was to compare the bone loss and the influence of physical activity between premenopausal women with rheumatoid arthritis (RA) and healthy women. A total of 71 patients with RA and 29 healthy premenopausal women with the criteria of the American College of Rheumatology for RA were followed for 2 years. Of these 85% were Caucasian, aged 38 +/- 6.6 years and with a duration of disease of 88 +/- 50 months and 48 (71.8%) used GC, mean daily dose, 7.3 +/- 3.5 mg. There was a reduction in the T-score of the femoral neck (P = 0.04) and in the Ward region (P = 0.05) in RA. Through logistic regression, it was found that sedentarism was a risk factor for osteopenia in RA, with relative risk of 1.6 (IC = 1.238-1.734). Moderate physical activity reduced the risk of osteopenia by 50%. Sedentarism and low weight are the main factors associated with bone loss. Physical activity reduces bone loss. Early preventive and therapeutic measures must be encouraged.

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Glucocorticoids (GC) are used in almost all medical specialties, and approximately 0.5% of the general population of the United Kingdom receives those medications. With the increased survival of patients with rheumatological diseases, morbidity secondary to the use of those medications represents an important aspect of the management of our patients. The incidences of vertebral and non-vertebral fractures are elevated, ranging from 30% to 50% of the individuals on GC for over three months. Thus, osteoporosis and frailty fractures should be prevented and treated in all patients initiating or already on GC. There are several recommendations on this topic elaborated by several international societies, but consensus still lacks. Recently, the American College of Rheumatology has published new recommendations, but they are based on the WHO Fracture Risk Assessment Tool (FRAX®) to evaluate the risk for each individual, and, thus, cannot be completely used for the Brazilian population. Thus, the Committee for Osteoporosis and Bone Metabolic Disorders of the Brazilian Society of Rheumatology, along with the Brazilian Medical Association and the Brazilian Association of Physical Medicine and Rehabilitation, has elaborated the Brazilian Guidelines for Glucocorticoid-Induced Osteoporosis (GIO), based on the better available scientifi c evidence and/or expert experience. Method of evidence collection: The bibliographic review of scientifi c articles of this guideline was performed in the MEDLINE database. The search for evidence was based on real clinical scenarios, and used the following keywords (MeSH Osteoporosis/prevention & control, Calcium, Vitamin D, Vitamin D defi ciency, Calcitriol, Receptors, Calcitriol; Hydroxycholecalciferols, Prevention and Control, Spinal fractures/prevention & control, Fractures, Spontaneous, Lumbar Vertebrae/injuries, Lifestyle, Alcohol Drinking, Smoking OR tobacco use disorder, Movement, Resistance Training, Exercise Therapy, Bone density OR Bone and Bones, Densitometry, Radiography, (Diphosphonates Alendronate OR Risedronate Pamidronate OR propanolamines OR Ibandronate OR Zoledronic acid, Men AND premenopause, pregnancy, pregnancy outcome maternal, fetus, lactation, teratogens,, adolescence (13-18 years). Grade of recommendation and level of evidence: A) Data derived from more consistent experimental and observational studies; B) Data derived from less consistent experimental and observational studies; C) Case reports (uncontrolled studies); D) Expert opinion without explicit critical appraisal, or based on consensus, physiological studies or animal models. Objective: To establish guidelines for the prevention and treatment of GIO.

INTRODUÇÃORecentes avanços na densitometria clínica têm incorporado novas tecnologias, técnicas de aquisição, aperfeiçoa-mento dos relatórios, novos bancos de dados e alterações de terminologia. O estabelecimento desses novos conceitos tem implicação na avaliação clínica individual dos pacientes, assim como influência potencial no direcionamento de políticas públicas de saúde. No sentido de clarificar novos conceitos e incorporá-los no dia-a-dia da prática médica em nosso país, a Sociedade Brasileira de Densitometria Clínica (SBDens) periodicamente reúne especialistas para estabelecer recomendações com base em revisões da literatura científica, levando em conta possíveis adaptações às condições próprias brasileiras. Essas recomendações, quando caracterizadas como posições oficiais de uma sociedade mé-dica, têm várias e importantes funções. Em primeiro lugar, padronizam a prática do método, uniformizando condutas e decisões entre os diferentes profissionais e centros do país. Adicionalmente, a observância às posições oficiais esclarece as questões maiores que necessitam de evidências científicas, estimulando os profissionais a reverem metodologias para a validação de sua prática profissional. Finalmente, pode-se dizer que as posições oficiais cumprem um importante papel no respaldo de decisões médico-legais. Quando posições oficiais validadas por nossas sociedades de especialidade são seguidas, falhas profissionais por insuficiências na literatura não podem ser creditadas aos médicos individualmente, uma vez que fica implícita a vinculação do médico ao consenso disponível na área e sua dedicação em acompanhar o desenvolvimento da profissão. A Sociedade Internacional de Densitometria Clínica (ISCD) elaborou em 2005 normas para a feitura e avaliação da densitometria óssea, aperfeiçoando a prática pregressa e incorporando novos rev bras reumatol, v. 47, n.1, p. 25-33, jan/fev, 2007

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