An update of the Malaysian Clinical Guidance on the management of glucocorticoid-induced osteoporosis, 2015
| Autor: | Fen Lee Hew, Joon Kiong Lee, Premitha Damodaran, Swan Sim Yeap, Winnie Siew Swee Chee, Emily Man Lee Goh, Siew Pheng Chan |
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| Rok vydání: | 2017 |
| Předmět: |
Pediatrics
medicine.medical_specialty lcsh:Diseases of the musculoskeletal system Osteoporosis Alternative medicine MEDLINE Review Article Guidelines Cochrane Library 03 medical and health sciences 0302 clinical medicine medicine Corticosteroids In patient 030212 general & internal medicine Glucocorticoids 030203 arthritis & rheumatology business.industry Malaysia Evidence-based medicine medicine.disease Orthopedic surgery Physical therapy lcsh:RC925-935 business Glucocorticoid medicine.drug |
| Zdroj: | Osteoporosis and Sarcopenia Osteoporosis and Sarcopenia, Vol 3, Iss 1, Pp 1-7 (2017) |
| ISSN: | 2405-5255 |
| DOI: | 10.1016/j.afos.2017.01.001 |
| Popis: | Objectives This Clinical Guidance is aimed to help practitioners assess, diagnose and manage their patients with glucocorticoid-induced osteoporosis (GIO), using the best available evidence. Methods A literature search using PubMed (MEDLINE) and The Cochrane Library identified all relevant articles on GIO and its assessment, diagnosis and treatment, from 2011, to update from the 2012 edition. The studies were assessed and the level of evidence assigned. For each statement, studies with the highest level of evidence were used to frame the recommendation. Results Consider treatment early in all patients on glucocorticoids (GC) as fracture risk increases within 3–6 months of starting GC. The decision to start treatment for GIO depends on the presence of prior fracture, category of risk (as calculated using Fracture Risk Assessment Tool), daily dose and duration of GC treatment, age, and menopausal status. General measures include adequate calcium and vitamin D intake and reducing the dose of GC to the minimum required to achieve disease control. In patients on GC with osteoporotic fractures or confirmed osteoporosis on dual-energy X-ray absorptiometry, bisphosphonates are the first-line treatment. Treatment should be continued as long as patients remain on GC. Algorithms for the management of GIO in both pre- and post-menopausal women and men have been updated. Conclusions In post-menopausal women and men above 50 years, bisphosphonates remain the mainstay of treatment in GIO. In pre-menopausal women and men below 50 years, bisphosphonates are recommended for those with a prevalent fracture or at very high risk only. |
| Databáze: | OpenAIRE |
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