Definition and management of very high fracture risk in women with postmenopausal osteoporosis: a position statement from the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Association of Bone Assessment and Metabolism (ABRASSO)

Silva, Barbara C.; Madeira, Miguel; d’Alva, Catarina Brasil; Maeda, Sérgio Setsuo; Holanda, Narriane Chaves Pereira de; Ohe, Monique Nakayama; Szejnfeld, Vera Lúcia; Zerbini, Cristiano A. F.; Paula, Francisco José Albuquerque de; Bandeira, Francisco

doi:10.20945/2359-3997000000522

“…As in prior guidelines, we used risk categories of low, moderate, and high using DXA and/or FRAX assessments (see Table 1). Similar to other recent OP guidelines (33‐35) (United Kingdom National Osteoporosis Guideline Group [NOGG], American Association of Clinical Endocrinologists [AACE], Brazilian Society of Endocrinology and Metabolism [SBEM]), we further identified a very high risk group with prior osteoporotic fractures, very low BMDs, very high FRAX risks, or high daily dose or high cumulative doses of glucocorticoids.…”

Section: Recommendationsmentioning

confidence: 77%

“…We risk stratified patients as low, moderate, high or very high risk of fracture based on FRAX 10‐year probability and DXA t‐ or z‐scores (Table 1). Similar to other organizational postmenopausal OP guidelines (AACE, SBEM, UK, and National Osteoporosis Foundation (NOF)) (33–35), we have now included a very high fracture risk category (prior OP fracture(s) or BMD t ‐score ≤−3.5 or FRAX (GC‐Adjusted) 10‐year risk of MOF ≥30% or hip ≥4.5% or high GC ≥30 mg/day for >30 days or cumulative doses ≥5 g/year) (Figures 2, 3, and5). These cut points were used to stratify PICO questions and weigh potential benefits versus harms of OP therapy.…”

Section: Discussionmentioning

confidence: 99%

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

Humphrey,

Russell,

Danila

et al. 2023

Arthritis & Rheumatology

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ObjectiveThe 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.MethodsAn 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.ResultsFor 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.ConclusionThis 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.

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“…It has been suggested that age is an important factor in increasing the risk of morbidity for all types of osteoporotic fractures 13 . The results of a retrospective study suggest that the effects of oestrogen deficiency on bone loss and impaired microstructure of bone tissue in postmenopausal women are more severe with age and that the risk of subsequent fracture increases with age 3 .…”

Section: Discussionmentioning

confidence: 99%

“…The risk factors for osteoporosis have been widely studied 13 . The risk factors for subsequent fracture are complex and multidimensional 12 .…”

Section: Introductionmentioning

confidence: 99%

Risk analysis for subsequent fracture of osteoporotic fractures in Chinese women over age 60: a nationwide cross-sectional study

Tang,

Gao,

Song

et al. 2024

Sci Rep

1

0

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Prevention of subsequent fracture is a major public health challenge in the field of osteoporosis prevention and treatment, and older women are at high risk for osteoporotic fractures. This study aimed to examine factors associated with subsequent fracture in older Chinese women with osteoporosis. We collected data on 9212 older female patients with osteoporotic fractures from 580 medical institutions in 31 provinces of China. Higher odds of subsequent fractures were associated with age of 70–79 years (OR 1.218, 95% CI 1.049–1.414), age ≥ 80 (OR 1.455, 95% CI 1.222–1.732), index fracture site was vertebrae (OR 1.472, 95% CI 1.194–1.815) and hip (OR 1.286, 95% CI 1.041–1.590), index fracture caused by fall (OR 1.822, 95% CI 1.281–2.591), strain (OR 1.587, 95% CI 1.178–2.139), no inducement (OR 1.541, 95% CI 1.043–2.277), and assessed as high risk of fracture (OR 1.865, 95% CI 1.439–2.416), BMD T-score ≤ −2.5 (OR 1.725, 95% CI 1.440–2.067), history of surgery (OR 3.941, 95% CI 3.475–4.471) and trauma (OR 8.075, 95% CI 6.941–9.395). Low risk of fall (OR 0.681, 95% CI 0.513–0.904), use of anti-osteoporosis medication (AOM, OR 0.801, 95% CI 0.693–0.926), and women who had received fall prevention health education (OR 0.583, 95% CI 0.465–0.730) associated with lower risk. The areas under the curve of the prediction model was 0.818. The sensitivity was 67.0% and the specificity was 82.0%. The prediction model showed a good ability to predict the risk of subsequent fracture in older women with osteoporotic fractures and are suitable for early self-measurement which may benefit post-fracture management.

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

Humphrey,

Russell,

Danila

et al. 2023

Arthritis Care & Research

3

0

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ObjectiveThe 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.MethodsAn 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.ResultsFor 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.ConclusionThis 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.

show abstract

Definition and management of very high fracture risk in women with postmenopausal osteoporosis: a position statement from the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Association of Bone Assessment and Metabolism (ABRASSO)

Abstract: a Member of the Sociedade Brasileira de Endocrinologia e Metabolismo (SBEM). b Member of the Associação Brasileira de Avaliação Óssea e Osteometabolismo (ABRASSO).

Cited by 4 publications

References 105 publications

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

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

Risk analysis for subsequent fracture of osteoporotic fractures in Chinese women over age 60: a nationwide cross-sectional study

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

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