2022 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis.

Autor: Humphrey MB; University of Oklahoma Health Sciences Center and U.S. Department of Veterans Affairs, Oklahoma City, Oklahoma., Russell L; Hospital for Special Surgery, New York, New York., Danila MI; University of Alabama at Birmingham and Birmingham VA Medical Center, Birmingham, Alabama., Fink HA; Geriatric Research Education and Clinical Center, VA Health Care System, Minneapolis, Minnesota., Guyatt G; McMaster University, Hamilton, Ontario, Canada., Cannon M; Arthritis Consultants of Tidewater, Virginia Beach, Virginia., Caplan L; University of Colorado, Denver., Gore S; Oklahoma City, Oklahoma., Grossman J; UCLA Health, Los Angeles, California., Hansen KE; University of Wisconsin, Madison., Lane NE; UC Davis Health, Sacramento, California., Ma NS; Children's Hospital Colorado, University of Colorado School of Medicine, Aurora., Magrey M; Case Western Reserve University, MetroHealth, Cleveland, Ohio., McAlindon T; Tufts University, Boston, Massachusetts., Robinson AB; Cleveland Clinic Foundation, Cleveland, Ohio., Saha S; University of Wisconsin, Madison., Womack C; Oklahoma City, Oklahoma., Abdulhadi B; University of Alabama at Birmingham and Birmingham VA Medical Center, Birmingham, Alabama., Charles JF; Brigham and Women's Hospital, Boston, Massachusetts., Cheah JTL; UMass Memorial Health and UMass Chan Medical School, Worcester, Massachusetts., Chou S; Brigham and Women's Hospital, Boston, Massachusetts., Goyal I; University of Oklahoma Health Sciences Center and U.S. Department of Veterans Affairs, Oklahoma City, Oklahoma., Haseltine K; Hospital for Special Surgery, New York, New York., Jackson L; University of Alabama at Birmingham and Birmingham VA Medical Center, Birmingham, Alabama., Mirza R; McMaster University, Hamilton, Ontario, Canada., Moledina I; University of Alabama at Birmingham and Birmingham VA Medical Center, Birmingham, Alabama., Punni E; University of Oklahoma Health Sciences Center and U.S. Department of Veterans Affairs, Oklahoma City, Oklahoma., Rinden T; University of Minnesota, Minneapolis., Turgunbaev M; American College of Rheumatology, Atlanta, Georgia., Wysham K; VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle, Washington., Turner AS; American College of Rheumatology, Atlanta, Georgia., Uhl S; ECRI Institute, Plymouth Meeting, Pennsylvania.
Jazyk: angličtina
Zdroj: Arthritis care & research [Arthritis Care Res (Hoboken)] 2023 Dec; Vol. 75 (12), pp. 2405-2419. Date of Electronic Publication: 2023 Oct 26.
DOI: 10.1002/acr.25240
Abstrakt: Objective: The objective is to update recommendations for prevention and treatment of glucocorticoid-induced osteoporosis (GIOP) for patients with rheumatic or nonrheumatic conditions receiving >3 months treatment with glucocorticoids (GCs) ≥2.5 mg daily.
Methods: An updated systematic literature review was performed for clinical questions on nonpharmacologic, pharmacologic treatments, discontinuation of medications, and sequential therapy. Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the certainty of evidence. A Voting Panel achieved ≥70% consensus on the direction (for or against) and strength (strong or conditional) of recommendations.
Results: For adults beginning or continuing >3 months of GC treatment, we strongly recommend as soon as possible after initiation of GCs, initial assessment of fracture risks with clinical fracture assessment, bone mineral density with vertebral fracture assessment or spinal x-ray, and Fracture Risk Assessment Tool if ≥40 years old. For adults at medium, high, or very high fracture risk, we strongly recommend pharmacologic treatment. Choice of oral or intravenous bisphosphonates, denosumab, or parathyroid hormone analogs should be made by shared decision-making. Anabolic agents are conditionally recommended as initial therapy for those with high and very high fracture risk. Recommendations are made for special populations, including children, people with organ transplants, people who may become pregnant, and people receiving very high-dose GC treatment. New recommendations for both discontinuation of osteoporosis therapy and sequential therapies are included.
Conclusion: This guideline provides direction for clinicians and patients making treatment decisions for management of GIOP. These recommendations should not be used to limit or deny access to therapies.
(© 2023 American College of Rheumatology. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)
Databáze: MEDLINE
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