Rosa M R Pereira1, Mariana O Perez2, Ana Patrícia Paula3, Caio Moreira4, Charlles H M Castro5, Cristiano A F Zerbini6, Diogo S Domiciano2, Elaine de Azevedo7, Laura M C Mendonca8, Marcia Midore Shinzato9, Marco Antonio A da Rocha-Loures10, Sebastião Radominski11, Vera L Szejnfeld5. 1. Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3193, Sao Paulo, SP, 01246-903, Brazil. rosamariarp@yahoo.com. 2. Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3193, Sao Paulo, SP, 01246-903, Brazil. 3. Rheumatology Division, Faculdade de Ciências da Saúde, Universidade de Brasilia (UnB), Brasilia, DF, Brazil. 4. Rheumatology Division, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. 5. Rheumatology Division, Universidade Federal de Sao Paulo-Escola Paulista de Medicina, Sao Paulo, SP, Brazil. 6. Rheumatology Division, Centro Paulista de Investigação Clínica, Sao Paulo, SP, Brazil. 7. Rheumatology Division, Hospital do Servidor Público Estadual de Sao Paulo, Sao Paulo, SP, Brazil. 8. Rheumatology Division, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil. 9. Rheumatology Division, Faculdade de Ciências da Saúde da Universidade Federal da Grande Dourados, Dourados, MS, Brazil. 10. Rheumatology Division, Universidade Estadual de Maringá (UEM), Maringá, PR, Brazil. 11. Rheumatology Division, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil.
Abstract
The Brazilian guidelines for prevention and treatment of glucocorticoid-induced osteoporosis were updated and important topics were included such as assessment of risk fracture using FRAX Brazil, use of denosumab, and also recommendations for the use of glucocorticoid pulse therapy and inhaled glucocortiocoid. INTRODUCTION: Glucocorticoids (GCs) are used in almost all medical specialties and the incidences of vertebral/nonvertebral fractures range from 30 to 50% in individuals treated with GCs for over 3 months. Thus, osteoporosis and frailty fractures should be prevented and treated in patients initiating treatment or already being treated with GCs. The Committee for Osteoporosis and Bone Metabolic Disorders of the Brazilian Society of Rheumatology (BSR) established in 2012 the Brazilian Guidelines for glucocorticoid-induced osteoporosis (GIO). Herein, we provide a comprehensive update of the original guidelines based on improved available scientific evidence and/or expert experience. METHODS: From March to June 2020, the Osteoporosis Committee of the BRS had meetings to update the questions presented in the first consensus (2012). Thus, twenty-six questions considered essential for the preparation of the recommendations were selected. A systematic literature review based on real-life scenarios was undertaken to answer the proposed questions. The MEDLINE, EMBASE, and SCOPUS databases were searched using specific search keywords. RESULTS: Based on the review and expert opinion, the recommendations were updated for each of the 26 questions. We included 48 new bibliographic references that became available after the date of the publication of the first version of the consensus. CONCLUSION: We updated the Brazilian guidelines for the prevention/treatment of GIO. New topics were added in this update, such as the assessment of risk fracture using FRAX Brazil, the use of denosumab, and approaches for the treatment of children and adolescents. Furthermore, we included recommendations for the use of inhaled GCs and GC pulse therapy in clinical settings.
The Brazilian guidelines for prevention and treatment of glucocorticoid-induced osteoporosis were updated and important topics were included such as assessment of risk fracture using FRAX Brazil, use of denosumab, and also recommendations for the use of glucocorticoid pulse therapy and inhaled glucocortiocoid. INTRODUCTION: Glucocorticoids (GCs) are used in almost all medical specialties and the incidences of vertebral/nonvertebral fractures range from 30 to 50% in individuals treated with GCs for over 3 months. Thus, osteoporosis and frailty fractures should be prevented and treated in patients initiating treatment or already being treated with GCs. The Committee for Osteoporosis and Bone Metabolic Disorders of the Brazilian Society of Rheumatology (BSR) established in 2012 the Brazilian Guidelines for glucocorticoid-induced osteoporosis (GIO). Herein, we provide a comprehensive update of the original guidelines based on improved available scientific evidence and/or expert experience. METHODS: From March to June 2020, the Osteoporosis Committee of the BRS had meetings to update the questions presented in the first consensus (2012). Thus, twenty-six questions considered essential for the preparation of the recommendations were selected. A systematic literature review based on real-life scenarios was undertaken to answer the proposed questions. The MEDLINE, EMBASE, and SCOPUS databases were searched using specific search keywords. RESULTS: Based on the review and expert opinion, the recommendations were updated for each of the 26 questions. We included 48 new bibliographic references that became available after the date of the publication of the first version of the consensus. CONCLUSION: We updated the Brazilian guidelines for the prevention/treatment of GIO. New topics were added in this update, such as the assessment of risk fracture using FRAX Brazil, the use of denosumab, and approaches for the treatment of children and adolescents. Furthermore, we included recommendations for the use of inhaled GCs and GC pulse therapy in clinical settings.
Authors: P P Geusens; R N J de Nijs; W F Lems; R F J M Laan; A Struijs; T P van Staa; J W J Bijlsma Journal: Ann Rheum Dis Date: 2004-03 Impact factor: 19.103
Authors: Gabriel P Esteves; Bruna Caruso Mazzolani; Fabiana Infante Smaira; Elizabeth Silva Mendes; Gabriela Guimarães de Oliveira; Hamilton Roschel; Bruno Gualano; Rosa Maria R Pereira; Eimear Dolan Journal: Rheumatol Adv Pract Date: 2022-04-21