Argentine Guidelines for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis in Postmenopausal Women and Men Aged 50 Years and Older

Abstract

Objective The aim of this study was to provide an evidence-based framework to guide health care professionals treating patients under glucocorticoid (GC) therapy and develop guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis (GIO) in postmenopausal women and men aged ≥50 years. Methods An expert panel on bone diseases designed a series of clinically meaningful questions following the PICO (Population, Intervention, Comparator, and Outcome) structure. Using GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology, we made a systematic literature review, extracted and summarized the effect estimates, and graded the quality of the evidence. The expert panel voted each PICO question and made recommendations after reaching an agreement of at least 70%. Results Seventeen recommendations (9 strong and 8 conditional) and 8 general principles were developed for postmenopausal women and men aged ≥50 years under GC treatment. Bone mineral density (BMD), occurrence of fragility fractures, probability of fracture at 10 years by Fracture Risk Assessment Tool, and other screening factors for low BMD are recommended for patient evaluation and stratification according to fragility fracture risk. The treatment of patients under GC therapy should include counseling on lifestyle habits and strict control of comorbidities. The goal of GIO treatment is the nonoccurrence of new fragility fractures as well as to increase or maintain BMD in certain clinical situations. This was considered for the therapeutic approach in different clinical scenarios. Conclusions This GIO guideline provides evidence-based guidance for health care providers treating patients.

Causal Relationship Between Systemic Lupus Erythematosus and Osteoporosis: A Mendelian Randomization Analysis

“…Given the potential causality between SLE and osteoporosis identi ed here, it is imperative that clinicians and researchers be aware of this connection. Early identi cation of osteoporosis risk in SLE patients allows healthcare providers to monitor and implement preventive measures against the development of this condition [34,35]. Preventative measures, such as promoting adequate calcium and vitamin D intake[36], encouraging regular weight-bearing exercise, and considering the use of bone-protecting medications, such as bisphosphonates and denosumab [37], may be crucial in mitigating the increased risk of osteoporosis in SLE patients [38].…”

Response to Letter to the Editor

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W e thank the editors for allowing us to respond to the letter to the editor about our recently published article in the Journal of Clinical Rheumatology titled "Argentine Guidelines for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis in Postmenopausal Women and Men Aged 50 Years and Older." 1 In addition, we thank the authors of the letter to the editor for their interest in our article.(1) Guidelines are recommended for patients older than 50 years. Most patients, especially those with rheumatologic conditions (connective tissue diseases, rheumatoid arthritis, etc.

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“…We thank the editors for allowing us to respond to the letter to the editor about our recently published article in the Journal of Clinical Rheumatology titled “Argentine Guidelines for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis in Postmenopausal Women and Men Aged 50 Years and Older.” 1 …”

Argentine Guidelines for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis in Postmenopausal Women and Men Aged 50 Years and Older

“…We read with interest the publication by Brance et al, 1 related to the Argentine Guidelines for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis in Postmenopausal Women and Men Aged 50 Years and Older in the Journal of Clinical Rheumatology .…”