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Guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis: an update of Brazilian Society of Rheumatology (2020)

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Abstract

Summary

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.

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Acknowledgements

The authors thank Jozelio Freire de Carvalho, Helenice Gonçalves, Jaime S Danowski, João Francisco Marques Neto, Mailze C Bezerra, Maria Teresa Terreri, Marta Imamura, Pedro Weingrill, Perola G Plapler, Tatiana Tourinho, and Nathalia C Andrada for providing expert advice in “2012 guidelines for prevention and treatment of Glucocorticoid-induced osteoporosis of the Brazilian Society of Rheumatology.”

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Authors and Affiliations

  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

    Rosa M. R. Pereira, Mariana O. Perez & Diogo S. Domiciano

  2. Rheumatology Division, Faculdade de Ciências da Saúde, Universidade de Brasilia (UnB), Brasilia, DF, Brazil

    Ana Patrícia Paula

  3. Rheumatology Division, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil

    Caio Moreira

  4. Rheumatology Division, Universidade Federal de Sao Paulo—Escola Paulista de Medicina, Sao Paulo, SP, Brazil

    Charlles H. M. Castro & Vera L. Szejnfeld

  5. Rheumatology Division, Centro Paulista de Investigação Clínica, Sao Paulo, SP, Brazil

    Cristiano A. F. Zerbini

  6. Rheumatology Division, Hospital do Servidor Público Estadual de Sao Paulo, Sao Paulo, SP, Brazil

    Elaine de Azevedo

  7. Rheumatology Division, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil

    Laura M. C. Mendonca

  8. Rheumatology Division, Faculdade de Ciências da Saúde da Universidade Federal da Grande Dourados, Dourados, MS, Brazil

    Marcia Midore Shinzato

  9. Rheumatology Division, Universidade Estadual de Maringá (UEM), Maringá, PR, Brazil

    Marco Antonio A. da Rocha-Loures

  10. Rheumatology Division, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil

    Sebastião Radominski

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  1. Rosa M. R. Pereira
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  2. Mariana O. Perez
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All authors contributed to write and review the manuscript. All authors read and approved the final version of the manuscript.

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Correspondence to Rosa M. R. Pereira.

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Conflicts of interest

Zerbini C received grants from Pfizer, Lilly, Novartis, Amgen and GSK. Rocha-Loures MAA received grants from Novarts and EMS. The other authors declare that they have no conflict of interest.

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Pereira, R.M.R., Perez, M.O., Paula, A.P. et al. Guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis: an update of Brazilian Society of Rheumatology (2020). Arch Osteoporos 16, 49 (2021). https://doi.org/10.1007/s11657-021-00902-z

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