Recomendaciones de la Sociedad Española de Reumatología sobre osteoporosis

Intervention Thresholds for Treatment in Patients with Glucocorticoid-Induced Osteoporosis: Systematic Review of Guidelines

“…Eight of the guidelines were developed specifically for GIOP [11,12,15,16,[19][20][21][22] whereas 6 cover overall osteoporosis including GIOP. [10,17,18,[23][24][25] Of these guidelines, 5 were newly developed [12,15,16,19,20] and the rest were updated guidelines.…”

“…[15,[17][18][19]22] On the other hand, recently revised or developed guidelines recommend that the initial fracture risk should be estimated using the FRAX score adjusted for GC dose and BMD values. [10][11][12]20,25] Some of these guidelines suggest that BMD testing could be performed conditionally depending on the results of the FRAX-based fracture probabilities. For example, the NOGG provides an algorithm to perform BMD measurements using DXA when an individual is at intermediate risk calculated by the FRAX model, and then reestimate the fracture probability using FRAX.…”

“…[10] A similar approach is suggested by the Spanish Society of Rheumatology (SER), which suggests that bone densitometry is required if the 10-year probability of major osteoporotic fracture using FRAX is greater than 5%. [25] The recommendations in most guidelines discuss postmenopausal women and men aged over 50 or 60. The guidelines from the ACR and the KSBMR/KCR present recommendations for younger patients separately.…”

“…Six out of 10 guidelines published after 2012 (6 GIOP-specific and 4 overall osteoporosis) adopt FRAX as the main criteria for deciding who should be treated. [10][11][12]20,22,25] A dose greater than 5 or 7.5 mg of prednisone equivalents per day with a 3-month minimum duration was proposed as a threshold for preventive therapy in most guidelines. [10,[15][16][17][18][19][20][22][23][24] In addition, it was recommended that GC users with a prior fragility fracture start anti-osteoporosis intervention regardless of other risk factors.…”

“…[10,15,20,22] Of the 7 guidelines which include BMD score as a threshold for pharmacological therapy for postmenopausal women, 4 guidelines proposed a T-score threshold of −1.5 or less. [15,17,20,25] However, the French Society for Rheumatology and Osteoporosis Research and Information Group (SFR/GRIO), ACR, and KSBMR/KCR guidelines set a T-score threshold of −2.5 or less, which is the same value usually accepted as postmenopausal osteoporosis, instead of a less stringent T-score threshold. [11,12,22] For FRAX, the intervention thresholds in each guideline are divided into age-dependent thresholds and fixed-thresholds.…”