Threshold based on bone mineral density for therapeutic decision-making in postmenopausal women and men over 50 years old under glucocorticoid therapy

Brance, María Lorena; Larroudé, M.S.; Somma, Luis Fernando; Giacoia, Evangelina; Diehl, María; Galich, A.M.; Stieben, Luis Agustín Ramírez; Maher, María Cielo; Vega, María De La; Ringer, A. I.; Brun, L.R.

doi:10.1016/j.reuma.2022.10.002

Cited by 4 publications

(2 citation statements)

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“…On the other hand, for those patients with T-score ≤ −1.7 without fragility fracture (moderate risk of fracture), oral bisphosphonates were recommended as the first option of treatment in most clinical situations, except contraindications, intolerance, or poor adherence. The use of a T-score of −1.7 as the threshold for intervention treatment 62 was defined after a systematic review analysis of previous studies, 57,58,72,73 indicating that more than 80% of the T-scores that discriminate between fractured and nonfractured were between −1.6 and −2.0. Although few studies have shown a T-score between −1.5 and −1.6 as a threshold of fracture, the use of a T-score value of −1.5 would lead to overtreatment of our study population.…”

Section: Discussionmentioning

confidence: 99%

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

Brance

Larroudé²,

Zamora³

et al. 2023

J Clin Rheumatol

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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.

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Section: Discussionmentioning

confidence: 99%

“…After the analysis of previous studies [60][61][62] considering a BMD threshold of fractures in GIO, we considered a T-score −1.7 for treatment in postmenopausal women and men ≥50 years old under GC therapy.…”

Section: Bone Mineral Density By Dxamentioning

confidence: 99%