Evidence based Latin American Guidelines of clinical practice on prevention, diagnosis, management and treatment of glucocorticoid induced osteoporosis. A 2022 update

Messina, Osvaldo Daniel; Vidal, Maritza; Torres, Jorge A Morales; Vidal, Luis; Arguissain, Constanza; Pereira, Rosa Maria Rodrigues; Clark, Patricia; Pérez, Sonia Cerdas; Campusano, Claudia; Lazaretti‐Castro, Marise; Zerbini, Cristiano A. F.; Scali, J J; Sanchez, Lucia Mendez; Peralta-Pedrero, Maria L.; Cavallo, Andrea; Ibarra, Francisco J. Valdivia; Pérez, Talina Hernandez

doi:10.1007/s40520-022-02261-2

Cited by 17 publications

(3 citation statements)

References 79 publications

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“…Finally, hormone overproduction impairs the overall bone turnover, favouring a reduced BMD (as pointed out above in subjects with ACS as well). A good level of evidence shows that anti-resorptive medications, such as bisphosphonates and denosumab, as well as bone-forming agents, such as teriparatide, counteract these pathogenic elements with good clinical results; thus, subjects with ACS/SH should be no exception according to the level of evidence that we have so far [ 131 , 132 , 133 , 134 , 135 ].…”

Section: Discussionmentioning

confidence: 99%

Management of Adrenal Cortical Adenomas: Assessment of Bone Status in Patients with (Non-Functioning) Adrenal Incidentalomas

Trandafir

Stanciu

Albu

et al. 2023

JCM

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Our aim is to analyse the bone profile in adults with (non-functioning) adrenal incidentalomas (AIs), specifically addressing the impact of autonomous cortisol secretion (ACS). This narrative review, based on a PubMed search from inception to February 2023 (case reports, non-ACS, and other secondary causes of osteoporosis were excluded), included 40 original studies, a total of 3046 patients with female prevalence (female:male ratio of 1921:1125), aged between 20.5 and 95.5 years old. This three decade-based analysis showed that 37 studies provided dual-energy X-ray absorptiometry (DXA) information; another five studies reports results on bone micro-architecture, including trabecular bone score (TBS), spinal deformity index, and high-resolution peripheral quantitative computed tomography; 20 cohorts included data on bone turnover markers (BTMs), while four longitudinal studies followed subjects between 1 and 10.5 years old (surgical versus non-adrenalectomy arms). Post-dexamethasone suppression test (DST) cortisol was inversely associated with bone mineral density (BMD). TBS predicted incidental vertebral fractures (VFx) regardless of BMD, being associated with post-DST cortisol independently of age and BMD. Low BTMs were identified in ACS, but not all studies agreed. An increased prevalence of ACS-related osteoporosis was confirmed in most studies (highest prevalence of 87.5%), as well as of VFx, including in pre-menopause (42.5%), post-menopause (78.6%), and male patients (72.7%) depending on the study, with a 10-fold increased incidental VFx risk up to a 12-fold increased risk after a 2-year follow-up. No specific medication against osteoporosis is indicated in ACS, but adrenalectomy (according to four studies) should be part of the long-term strategy. This bone profile case sample-based study (to our knowledge, one of the largest of its kind) showed that AIs, including the subgroup designated as having ACS, embraces a large panel of osseous complications. The level of evidence remains far from generous; there are still no homogenous results defining ACS and identifying skeletal involvement, which might be a consequence of different investigation clusters underling adrenal and bone assessments over time. However, bone status evaluations and associated therapy decisions remain an essential element of the management of adults with AIs-ACS.

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Section: Discussionmentioning

confidence: 99%

Management of Adrenal Cortical Adenomas: Assessment of Bone Status in Patients with (Non-Functioning) Adrenal Incidentalomas

Trandafir

Stanciu

Albu

et al. 2023

JCM

View full text Add to dashboard Cite

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“…In terms of the measurement of SII, the lymphocyte, neutrophil, and platelet counts are analyzed using the automated hematology analyzing devices and exhibited as ×10 3 cells/µL, and SII is calculated as platelet count × neutrophil count/lymphocyte count. As for the definition of osteoporosis, the BMD of lumbar spine and femur are measured using DXA (Siemens), and the condition of osteoporosis is evaluated according to the diagnosis from the international diagnostic guidelines, 23,24 and the diagnostic standard is described as t ‐score less than −2.5 standard deviation ( SD ). In addition, the definition of combined with hypertension and combined with diabetes are also assessed in accordance with corresponding international diagnostic guidelines 25,26 .…”

Section: Methodsmentioning

confidence: 99%

High systemic immune‐inflammation index is relevant to osteoporosis among middle‐aged and older people: A cross‐sectional study

Zhang,

2023

Immunity Inflam & Disease

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BackgroundAs one of novel inflammatory indexes proposed in recent years, systemic immune‐inflammation index (SII) can comprehensively reflect the inflammatory and immune state of the body. This study aims to explore the relationship between SII and osteoporosis among middle‐aged and older people.Materials and MethodsOur study includes 20,497 individuals from National Health and Nutrition Examination Survey (NHANES) 2005–2008, and target study population are confined to people aged 45 years and above. SII is calculated as platelet count × neutrophil count/lymphocyte count. Multivariate logistic regression analysis is used to explore the link between SII and osteoporosis, and receiver operating characteristics curve is used to screen optimal cut‐off value of SII for indicating the occurrence of osteoporosis.ResultsA total of 435 people with osteoporosis are screened among 4625 middle‐aged and older people, and individuals in osteoporosis group have higher SII than those in nonosteoporosis group (p = .024). Logistic regression analysis indicates that with the enhancement of SII, prevalence of osteoporosis in each tertile category also increases (p < .001). This tendency is also not changed in univariate model (p < .001), as well as the adjustments for different parameters. Moreover, we also identify that SII of 530.09 is the optimal cut‐off value for indicating the occurrence of osteoporosis among middle‐aged and older people.ConclusionsThis present NHANES‐based study noticed that higher SII is positively linked to osteoporosis among middle‐aged and older people, and SII should not exceed 530.09 for them to obtain a potentially lower risk of osteoporosis.

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“…Moreover, the effects on bones of long-term use of steroids in chronic illness have been studied since 1940 and are now wellknown, with a large portion of these subjects developing osteoporosis. In these subjects, osteoporosis usually begins quickly (approximately 3 months after treatment initiation) but reduces its progression over time (Sweiss et al, 2011;Cosman et al, 2014;Messina et al, 2022).…”

Section: Muscoloskeletal Systemmentioning

confidence: 99%

Safety of corticosteroid therapy in sarcoidosis treatment

Di Marco Berardino,

Mei,

Zuccatosta

2023

Front. Drug Saf. Regul.

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Introduction: Sarcoidosis is a multisystemic granulomatous disease of unknown origin and unpredictable cause, characterized by a dysregulated immune response. If histopathological hallmark is represented by the presence of non-caseating granulomas, clinical manifestations are variable and symptoms are not specific, and they depend on organs affected. Although thoracic involvement (lung and mediastinum) is the most common clinical manifestation, any organ can be virtually affected.Methods: This paper is structured as a narrative review. A literature search was performed in four electronic databases (Pubmed, Cochrane, Scopus, and Ovid Medline) and Google from inception until February 2023 for relevant studies, meta-analyses, and reviews on corticosteroids’ adverse events in sarcoidosis. English language only papers were included.Discussion: Although antimetabolites (such as Methotrexate) and immunosuppressant agents can be used as alternative therapy in refractory cases, traditionally systemic glucocorticoids represent the first choice for sarcoidosis treatment. However, their use is still debated, due to potential adverse effects, leading to a wide spectrum of complications particularly in patients who required long-term therapy. Hence, this article aims to provide a comprehensive updated review on the safety profile of glucocorticoid treatment in patients with sarcoidosis and their systemic effects.Conclusion: corticosteroids remain the first choice in Sarcoidosis, however, due to numerous side effects, dose and duration of treatment should be carefully adjusted and monitored by clinicians.

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Evidence based Latin American Guidelines of clinical practice on prevention, diagnosis, management and treatment of glucocorticoid induced osteoporosis. A 2022 update

Cited by 17 publications

References 79 publications

Management of Adrenal Cortical Adenomas: Assessment of Bone Status in Patients with (Non-Functioning) Adrenal Incidentalomas

Management of Adrenal Cortical Adenomas: Assessment of Bone Status in Patients with (Non-Functioning) Adrenal Incidentalomas

High systemic immune‐inflammation index is relevant to osteoporosis among middle‐aged and older people: A cross‐sectional study

Safety of corticosteroid therapy in sarcoidosis treatment

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