Guidelines For The Prevention And Treatment Of Glucocorticoid-induced Osteoporosis

Glucocorticoids (GC) are used in almost all medical specialties, and approximately 0.5% of the general population of the United Kingdom receives those medications. With the increased survival of patients with rheumatological diseases, morbidity secondary to the use of those medications represents an important aspect of the management of our patients. The incidences of vertebral and non-vertebral fractures are elevated, ranging from 30% to 50% of the individuals on GC for over three months. Thus, osteoporosis and frailty fractures should be prevented and treated in all patients initiating or already on GC. There are several recommendations on this topic elaborated by several international societies, but consensus still lacks. Recently, the American College of Rheumatology has published new recommendations, but they are based on the WHO Fracture Risk Assessment Tool (FRAX®) to evaluate the risk for each individual, and, thus, cannot be completely used for the Brazilian population. Thus, the Committee for Osteoporosis and Bone Metabolic Disorders of the Brazilian Society of Rheumatology, along with the Brazilian Medical Association and the Brazilian Association of Physical Medicine and Rehabilitation, has elaborated the Brazilian Guidelines for Glucocorticoid-Induced Osteoporosis (GIO), based on the better available scientifi c evidence and/or expert experience. Method of evidence collection: The bibliographic review of scientifi c articles of this guideline was performed in the MEDLINE database. The search for evidence was based on real clinical scenarios, and used the following keywords (MeSH terms): Osteoporosis, Osteoporosis/chemically induced*= (Glucocorticoids= Adrenal Cortex Hormones, Steroids), Glucocorticoids, Glucocorticoids/administration and dosage, Glucocorticoids/therapeutic use, Glucocorticoids/adverse effects, Prednisone/adverse effects, Dose-Response Relationship, Drug, Bone Density/drug effects, Bone Density Conservation Agents/pharmacological action, Osteoporosis/prevention & control, Calcium, Vitamin D, Vitamin D defi ciency, Calcitriol, Receptors, Calcitriol; 1-hydroxycholecalciferol, Hydroxycholecalciferols, 25-Hydroxyvitamin D3 1-alpha-hydroxylase OR Steroid Hydroxylases, Prevention and Control, Spinal fractures/prevention & control, Fractures, Spontaneous, Lumbar Vertebrae/injuries, Lifestyle, Alcohol Drinking, Smoking OR tobacco use disorder, Movement, Resistance Training, Exercise Therapy, Bone density OR Bone and Bones, Dual-Energy X-Ray Absorptiometry OR Absorptiometry Photon OR DXA, Densitometry, Radiography, (Diphosphonates Alendronate OR Risedronate Pamidronate OR propanolamines OR Ibandronate OR Zoledronic acid, Teriparatide OR PTH 1-34, Men AND premenopause, pregnancy, pregnancy outcome maternal, fetus, lactation, breast-feeding, teratogens, Children (6-12 years), adolescence (13-18 years). Grade of recommendation and level of evidence: A) Data derived from more consistent experimental and observational studies; B) Data derived from less consistent experimental and observational studies; C) Case reports (uncontrolled studies); D) Expert opinion without explicit critical appraisal, or based on consensus, physiological studies or animal models. Objective: To establish guidelines for the prevention and treatment of GIO. © 2012 Elsevier Editora Ltda.524580593Walsh, L.J., Wong, C.A., Pringle, M., Tattersfield, A.E., Use of oral corticosteroids in the community and the prevention of secondary osteoporosis: a cross sectional study (1996) BMJ, 313 (7053), pp. 344-346van Staa, T.P., Leufkens, H.G., Cooper, C., The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis (2002) Osteoporos Int, 13 (10), pp. 777-787Kaji, H., Yamauchi, M., Chihara, K., Sugimoto, T., The threshold of bone mineral density for vertebral fracture in female patients with glucocorticoid-induced osteoporosis (2006) Endocr J, 53 (1), pp. 27-34Van Staa, T.P., Laan, R.F., Barton, I.P., Cohen, S., Reid, D.M., Cooper, C., Bone density threshold and other predictors of vertebral fracture in patients receiving oral glucocorticoid therapy (2003) Arthritis Rheum, 48 (11), pp. 3224-3229Van Staa, T.P., Leufkens, H.G., Abenhaim, L., Zhang, B., Cooper, C., Use of oral corticosteroids and risk of fracture. June, 2000 (2005) J Bone Miner Res, 20 (8), pp. 1487-1494American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis (2001) Arthritis Rheum, 44 (7), pp. 1496-1503. , Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 updateAdler, R.A., Hochberg, M.C., Suggested guidelines for evaluation and treatment of glucocorticoid-induced osteoporosis for the Department of Veterans Affairs (2003) Arch Intern Med, 163 (21), pp. 2619-2624Geusens, P.P., de Nijs, R.N., Lems, W.F., Laan, R.F., Struijs, A., van Staa, T.P., Prevention of glucocorticoid osteoporosis: a consensus document of the Dutch Society for Rheumatology (2004) Ann Rheum Dis, 63 (3), pp. 324-325(2002) Glucocorticoidinduced Osteoporosis: guidelines for prevention and treatment, , National Osteoporosis Society & Royal College of Physicians guidelines working group for Bone and Tooth Society, London, Royal College of PhysiciansDevogelaer, J.P., Goemaere, S., Boonen, S., Body, J.J., Kaufman, J.M., Reginster, J.Y., Evidence-based guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis: a consensus document of the Belgian Bone Club (2006) Osteoporos Int, 17 (1), pp. 8-19Nawata, H., Soen, S., Takayanagi, R., Tanaka, I., Takaoka, K., Fukunaga, M., Guidelines on the management and treatment of glucocorticoid-induced osteoporosis of the Japanese Society for Bone and Mineral Research (2004) (2005) J Bone Miner Metab, 23 (2), pp. 105-109Grossman, J.M., Gordon, R., Ranganath, V.K., Deal, C., Caplan, L., Chen, W., American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis (2010) Arthritis Care Res (Hoboken), 62 (11), pp. 1515-1526Sambrook, P., Birmingham, J., Kelly, P., Kempler, S., Pocock, N., Eisman, J., Prevention of corticosteroid osteoporosis. A comparison of calcium, calcitriol and calcitonin (1993) N Engl J Med, 328 (24), pp. 1747-1752Yeap, S.S., Fauzi, A.R., Kong, N.C., Halim, A.G., Soehardy, Z., Rahimah, I., A comparison of calcium, calcitriol, and alendronate in corticosteroid-treated premenopausal patients with systemic lupus erythematosus (2008) J Rheumatol, 35 (12), pp. 2344-2347Poulos, P., Adachi, J.D., Guidelines for the prevention and therapy of glucocorticoid-induced osteoporosis (2000) Clin Exp Rheumatol, 18 (SUPPL. 21), pp. S79-S86Richy, F., Ethgen, O., Bruyere, O., Reginster, J.Y., Effi cacy of alfacalcidol and calcitriol in primary and corticosteroid-induced osteoporosis: a meta-analysis of their effects on bone mineral density and fracture rate (2004) Osteoporos Int, 15 (4), pp. 301-310Sambrook, P., Henderson, N.K., Keogh, A., MacDonald, P., Glanville, A., Spratt, P., Effect of calcitriol on bone loss after cardiac or lung transplantation (2000) J Bone Miner Res, 15 (9), pp. 1818-1824de Nijs, R.N., Jacobs, J.W., Algra, A., Lems, W.F., Bijlsma, J.W., Prevention and treatment of glucocorticoid-induced osteoporosis with active vitamin D3 analogues: a review with meta-analysis of randomized controlled trials including organ transplantation studies (2004) Osteoporos Int, 15 (8), pp. 589-602Ringe, J.D., Dorst, A., Faber, H., Schacht, E., Rahlfs, V.W., Superiority of alfacalcidol over plain vitamin D in the treatment of glucocorticoidinduced osteoporosis (2004) Rheumatol Int, 24 (2), pp. 63-70Homik, J., Suarez-Almazor, M.E., Shea, B., Cranney, A., Wells, G., Tugwell, P., Calcium and vitamin D for corticosteroid-induced osteoporosis (2000) Cochrane Database Syst Rev, (2), pp. CD000952Buckley, L.M., Leib, E.S., Cartularo, K.S., Vacek, P.M., Cooper, S.M., Calcium and vitamin D3 supplementation prevents bone loss in the spine secondary to low dose corticosteroids in patients with rheumatoid arthritis (1996) Ann Intern Med, 125 (12), pp. 961-968Jensen, J., Christiansen, C., Rødbro, P., Cigarette smoking, serum estrogens, and bone loss during hormone-replacement therapy early after menopause (1985) N Engl J Med, 313 (16), pp. 973-975Korkor, A.B., Eastwood, D., Bretzmann, C., Effects of gender, alcohol, smoking, and dairy consumption on bone mass in Wisconsin adolescents (2009) WMJ, 108 (4), pp. 181-188Teucher, B., Dainty, J.R., Spinks, C.A., Majsak-Newman, G., Berry, D.J., Hoogewerff, J.A., Sodium and bone health: impact of moderately high and low salt intakes on calcium metabolism in postmenopausal women (2008) J Bone Miner Res, 23 (9), pp. 1477-1485Pongchaiyakul, C., Nguyen, T.V., Kosulwat, V., Rojroongwasinkul, N., Charoenkiatkul, S., Eisman, J.A., Effects of physical activity and dietary calcium intake on bone mineral density and osteoporosis risk in a rural Thai population (2004) Osteoporos Int, 15 (10), pp. 807-813Ensrud, K.E., Ewing, S.K., Taylor, B.C., Fink, H.A., Stone, K.L., Cauley, J.A., Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures (2007) J Gerontol A Biol Sci Med Sci, 62 (7), pp. 744-751Morin, S., Tsang, J.F., Leslie, W.D., Weight and body mass index predict bone mineral density and fractures in women aged 40 to 59 years (2009) Osteoporos Int, 20 (3), pp. 363-370Hodgson, S.F., Watts, N.B., Bilezikian, J.P., Clarke, B.L., Gray, T.K., Harris, D.W., American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: 2001 edition, with selected updates for 2003 (2003) Endocr Pract, 9 (6), pp. 544-564Kohrt, W.M., Bloomfield, S.A., Little, K.D., Nelson, M.E., Yingling, V.R., American College of Sports Medicine. American College of Sports Medicine Position Stand: physical activity and bone health (2004) Med Sci Sports Exerc, 36 (11), pp. 1985-1996Schmitt, N.M., Schmitt, J., Dören, M., The role of physical activity in the prevention of osteoporosis in postmenopausal women (2009) An update. Maturitas, 63 (1), pp. 34-38Gillespie, L.D., Robertson, M.C., Gillespie, W.J., Lamb, S.E., Gates, S., Cumming, R.G., Interventions for preventing falls in older people living in the community (2009) Cochrane Database Syst Rev, 15 (2), pp. CD007146Maricic, M., Glucocorticoid-induced osteoporosis: treatment options and guidelines (2005) Curr Osteoporos Rep, 3 (1), pp. 25-29Braith, R.W., Magyari, P.M., Fulton, M.N., Aranda, J., Walker, T., Hill, J.A., Resistance exercise training and alendronate reverse glucocorticoidinduced osteoporosis in heart transplant recipients (2003) J Heart Lung Transplant, 22 (10), pp. 1082-1090Newman, E.D., Matzko, C.K., Olenginski, T.P., Perruquet, J.L., Harrington, T.M., Maloney-Saxon, G., Glucocorticoid-Induced Osteoporosis Program (GIOP): a novel, comprehensive, and highly successful care program with improved outcomes at 1 year (2006) Osteoporos Int, 17 (9), pp. 1428-1434de Jong, Z., Munneke, M., Lems, W.F., Zwinderman, A.H., Kroon, H.M., Pauwels, E.K., Slowing of bone loss in patients with rheumatoid arthritis by long-term high-intensity exercise: results of a randomized, controlled trial (2004) Arthritis Rheum, 50 (4), pp. 1066-1076Angeli, A., Guglielmi, G., Dovio, A., Capelli, G., de Feo, D., Giannini, S., High prevalence of asymptomatic vertebral fractures in postmenopausal women receiving chronic glucocorticoid therapy: a cross-sectional outpatient study (2006) Bone, 39 (2), pp. 253-259Lewiecki, E.M., Gordon, C.M., Baim, S., Leonard, M.B., Bishop, N.J., Bianchi, M.L., International Society for Clinical Densitometry 2007 Adult and Pediatric Offi cial Positions (2008) Bone, 43 (6), pp. 1115-1121Reid, D.M., Adami, S., Devogelaer, J.P., Chines, A.A., Risedronate increases bone density and reduces vertebral fracture risk within one year in men on corticosteroid therapy (2001) Calcif Tissue Int, 69 (4), pp. 242-247Cruse, L.M., Valeriano, J., Vasey, F.B., Carter, J.D., Prevalence of evaluation and treatment of glucocorticoid-induced osteoporosis in men (2006) J Clin Rheumatol, 12 (5), pp. 221-225Van Staa, Leufkens, H.G., Abenhaim, L., Zhang, B., Cooper, C., Use of Oral Corticosteroids and Risk of Fracture J Bone Min Res, 15 (6), p. 2000van Staa, T.P., Cooper, C., Leufkens, H.G., Bishop, N., Children and the risk of fractures caused by oral corticosteroids (2003) J Bone Miner Res, 18 (5), pp. 913-918Blodgett, F.M., Burgin, L., Iezzoni, D., Gribetz, D., Talbot, N.B., Effects of prolonged cortisone therapy on the statural growth, skeletal maturation and metabolic status of children (1956) N Engl J Med, 254 (14), pp. 636-641Varonos, S., Ansell, B.M., Reeve, J., Vertebral collapse in juvenile chronic arthritis: its relationship with glucocorticoid therapy (1987) Calcif Tissue Int, 41 (2), pp. 75-78Baim, S., Binkley, N., Bilezikian, J.P., Kendler, D.L., Hans, D.B., Lewiecki, E.M., Offi cial Positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD Position Development Conference (2008) J Clin Densitom, 11 (1), pp. 75-91Saag, K.G., Emkey, R., Schnitzer, T.J., Brown, J.P., Hawkins, F., Goemaere, S., Alendronate for the prevention and treatment of glucocorticoidinduced osteoporosis (1998) N Engl J Med, 339 (5), pp. 292-299Cohen, S., Levy, R.M., Keller, M., Boling, E., Emkey, R.D., Greenwald, M., Risedronate therapy prevents corticosteroid-induced bone loss: a twelve-month, multicenter, randomized, double-blind, placebo-controlled, parallel-group study (1999) Arthritis Rheum, 42 (11), pp. 2309-2318de Nijs, R.N., Jacobs, J.W., Lems, W.F., Laan, R.F., Algra, A., Huisman, A.M., Alendronate or alfacalcidol in glucocorticoid-induced osteoporosis (2006) N Engl J Med, 355 (7), pp. 675-684Wallach, S., Cohen, S., Reid, D.M., Hughes, R.A., Hosking, D.J., Laan, R.F., Effects of risedronate treatment on bone density and vertebral fracture in patients on corticosteroid therapy (2000) Calcif Tissue Int, 67 (4), pp. 277-285Adachi, J.D., Saag, K.G., Delmas, P.D., Liberman, U.A., Emkey, R.D., Seeman, E., Two-year effects of alendronate on bone mineral density and vertebral fracture in patients receiving glucocorticoids: a randomized, double-blind, placebo-controlled extension trial (2001) Arthritis Rheum, 44 (1), pp. 202-211Cohen, S., Levy, R.M., Keller, M., Boling, E., Emkey, R.D., Greenwald, M., Risedronate therapy prevents corticosteroid-induced bone loss: a twelve-month, multicenter, randomized, double-blind, placebo-controlled, parallel-group study (1999) Arthritis Rheum, 42 (11), pp. 2309-2318Black, D.M., Delmas, P.D., Eastell, R., Reid, I.R., Boonen, S., Cauley, J.A., Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis (2007) N Engl J Med, 356 (18), pp. 1809-1822Lyles, K.W., Colón-Emeric, C.S., Magaziner, J.S., Adachi, J.D., Pieper, C.F., Mautalen, C., Zoledronic acid in reducing clinical fracture and mortality after hip fracture (2007) N Engl J Med, 357, pp. 1799-1809Reid, D.M., Devogelaer, J.P., Saag, K., Roux, C., Lau, C.S., Reginster, J.Y., Zoledronic acid and risedronate in the prevention and treatment of glucocorticoid-induced osteoporosis (HORIZON): a multicentre, double-blind, double-dummy, randomised controlled trial (2009) Lancet, 373 (9671), pp. 1253-1263Rietbrock, S., Olson, M., van Staa, T.P., The potential effects on fracture outcomes of improvements in persistence and compliance with bisphosphonates (2009) QJM, 102 (1), pp. 35-42Lau, A.N., Adachi, J.D., Role of teriparatide in treatment of glucocorticoid-induced osteoporis (2010) Ther Clin Risk Manag, 6, pp. 497-503Canalis, E., Giustina, A., Bilezikian, I.P., Mechanisms of anabolic therapies for osteoporosis (2007) N Engl J Med, 357 (9), pp. 905-916Saag, K.G., Shane, E., Boonen, S., Marín, F., Donley, D.W., Taylor, K.A., Teriparatide or alendronate in glucocorticoid-induced osteoporosis (2007) N Engl J Med, 357 (20), pp. 2028-2039Saag, K.G., Zanchetta, J.R., Devogelaer, J.P., Adler, R.A., Eastell, R., See, K., Effects of teriparatide versus alendronate for treating glucocorticoid-induced osteoporosis: thirty-six-month results of a randomized, double-blind, controlled trial (2009) Arthritis Rheum, 60 (11), pp. 3346-3355Langdahl, B.L., Marin, F., Shane, E., Dobnig, H., Zanchetta, J.R., Maricic, M., Teriparatide versus alendronate for treating glucorticoid-induced osteoporosis: an analysis by gender and menopausal status (2009) Osteoporosis Int, 20 (12), pp. 2095-2104Maricic, M., Gluck, O., Densitometry in glucocorticoid-induced osteoporosis (2004) J Clin Densitometry, 7 (4), pp. 359-363Franchimont, N., Canalis, E., Management of glucocorticoid induced osteoporosis in premenopausal women with autoimmune disease (2003) Autoimmun Rev, 2 (4), pp. 224-228Winzenberg, T., Oldenburg, B., Frendin, S., De Wit, L., Riley, M., Jones, G., The effect on behavior and bone mineral density of individualized bone mineral density feedback and educational interventions in premenopausal women: a randomized controlled trial [NCT00273260] (2006) BMC Public Health, pp. 6-12Okada, Y., Nawata, M., Nakayamada, S., Saito, K., Tanaka, Y., Alendronate protects premenopausal women from bone loss and fracture associated with high-dose glucocorticoid therapy (2008) J Rheumatol, 35 (11), pp. 2249-2254Adachi, J.D., Bensen, W.G., Brown, J., Hanley, D., Hodsman, A., Josse, R., Intermittent etidronate therapy to prevent corticosteroidinduced osteoporosis (1997) N Engl J Med, 337 (6), pp. 382-387Patlas, N., Golomb, G., Yaffe, P., Pinto, T., Breuer, E., Ornoy, A., Transplacental effects of bisphosphonates on fetal skeletal ossification and mineralization in rats (1999) Teratology, 60 (2), pp. 68-73Minsker, D.H., Manson, J.M., Peter, C.P., Effects of the bisphosphonate, alendronate, on parturition in the rat (1993) Toxicol Appl Pharmacol, 121 (2), pp. 217-223Chan, B., Zacharin, M., Maternal and infant outcome after pamidronate treatment of polyostotic fibrous dysplasia and osteogenesis imperfecta before conception: a report of four cases (2006) J Clin Endocrinol Metab, 91 (6), pp. 2017-2020Ornoy, A., Wajnberg, R., Diav-Citrin, O., The outcome of pregnancy following pre-pregnancy or early pregnancy alendronate treatment (2006) Reprod Toxicol, 22 (4), pp. 578-579Dunlop, D.J., Soukop, M., McEwan, H.P., Antenatal administration of aminopropylidene diphosphonate (1990) Ann Rheum Dis, 49 (11), p. 955Illidge, T.M., Hussey, M., Godden, C.W., Malignant hypercalcaemia in pregnancy and antenatal administration of intravenous pamidronate (1996) Clin Oncol (R Coll Radiol), 8 (4), pp. 257-258Munns, C.F., Rauch, F., Ward, L., Glorieux, F.H., Maternal and fetal outcome after long-term pamidronate treatment before conception: a report of two cases (2004) J Bone Miner Res, 19 (10), pp. 1742-1745Djokanovic, N., Klieger-Grossmann, C., Koren, G., Does treatment with bisphosphonates endanger the human pregnancy? (2008) J Obstet Gynaecol Can, 30 (12), pp. 1146-1148Levy, S., Fayez, I., Taguchi, N., Han, J.Y., Aiello, J., Matsui, D., Pregnancy outcome following in utero exposure to bisphosphonates (2009) Bone, 44 (3), pp. 428-430Yarrington, J.T., Capen, C.C., Black, H.E., Re, R., Potts Jr, J.T., Geho, W.B., Experimental parturient hypocalcemia in cows following prepartal chemical inhibition of bone resportion (1976) Am J Pathol, 83 (3), pp. 569-588Bianchi, M.L., How to manage osteoporosis in children (2005) Best Pract Res Clin Rheumatol, 19 (6), pp. 991-1005Brown, J.J., Zacharin, M.R., Attempted randomized controlled trial of pamidronate versus calcium and calcitriol supplements for management of steroid-induced osteoporosis in children and adolescents (2005) J Paediatr Child Health, 41 (11), pp. 580-582Roth, J., Bechtold, S., Borte, G., Dressler, F., Girschick, H., Borte, M., Diagnosis, prophylaxis and therapy of osteoporosis in juvenile idiopathic arthritis: consensus statement of the German Association for Pediatric Rheumatology (2007) Z Rheumatol, 66 (5), pp. 434-440Bianchi, M.L., Cimaz, R., Bardare, M., Zulian, F., Lepore, L., Boncompagni, A., Efficacy and safety of alendronate for the treatment of osteoporosis in diffuse connective tissue diseases in children: a prospective multicenter study (2000) Arthritis Rheum, 43 (9), pp. 1960-1966Rudge, S., Hailwood, S., Horne, A., Lucas, J., Wu, F., Cundy, T., Effects of once-weekly oral alendronate on bone in children on glucocorticoids treatment (2005) Rheumatology (Oxford), 44 (6), pp. 813-818Noguera, A., Ros, J.B., Pavia, C., Alcover, E., Valls, C., Villaronga, M., Bisphosphonates, a new treatment for glucocorticoids-induced osteoporosis in children (2003) J Pediatr Endocrinol Metab, 16 (4), pp. 529-536Thornton, J., Ashcroft, D.M., Mughal, M.Z., Elliott, R.A., O'Neill, T.W., Symmons, D., Systematic review of effectiveness of bisphosphonates in treatment of low bone mineral density and fragility fractures in juvenile idiopathic arthritis (2006) Arch Dis Child, 91 (9), pp. 753-761Batch, J.A., Couper, J.J., Rodda, C., Cowell, C.T., Zacharin, M., Use of bisphosphonte therapy for osteoporosis in childhood and adolescence (2003) J Paediatr Child Health, 39 (2), pp. 88-9