A framework for the development of guidelines for the management of glucocorticoid-induced osteoporosis

Lekamwasam, Sarath; Adachi, Jonathan D.; Agnusdei, D.; Bilezikian, John P.; Boonen, Steven; Borgström, F.; Cooper, Cyrus; Pérez, Adolfo Díez; Eastell, Richard; Hofbauer, Lorenz C.; Kanis, John А.; Langdahl, Bente; Lesnyak, Olga; Lorenc, Roman; McCloskey, Eugène; Messina, Osvaldo Daniel; Napoli, Nicola; Obermayer–Pietsch, Barbara; Ralston, Stuart H.; Sambrook, Philip N.; Silverman, Stuart L.; Sosa, Manuel; Štěpán, J; Suppan, G.; Wahl, D. A.; Compston, Juliet

doi:10.1007/s00198-012-1958-1

Cited by 304 publications

(235 citation statements)

References 160 publications

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“…Comparing our results to those in other population-based cohorts, we think our results are conservative estimates of GIO risk and recommended treatment in the US (12)(13)(14)(15). The International Osteoporosis Foundation (IOF) and European Calcified Tissue Society (ECTS) working group (IOF-ECTS) and the Brazil Society for Rheumatology released GIO recommendations in 2012 with the European League Against Rheumatism (EULAR) in 2013 (49,50,51). All 4 guideline statements utilize glucocorticoid dose and duration for treatment recommendations, while the ACR, IOF-ECTS, and EULAR guidelines also use the FRAX 10-year risk of major osteoporotic fracture in their treatment determinations (30,49,50,51).…”

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confidence: 49%

“…The International Osteoporosis Foundation (IOF) and European Calcified Tissue Society (ECTS) working group (IOF-ECTS) and the Brazil Society for Rheumatology released GIO recommendations in 2012 with the European League Against Rheumatism (EULAR) in 2013 (49,50,51). All 4 guideline statements utilize glucocorticoid dose and duration for treatment recommendations, while the ACR, IOF-ECTS, and EULAR guidelines also use the FRAX 10-year risk of major osteoporotic fracture in their treatment determinations (30,49,50,51). In 2013 the National Osteoporosis Guidelines Group (NOGG) in the UK released guidelines using the IOF-ECTS guidelines for Europe (52).…”

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confidence: 99%

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United States Adults Meeting 2010 American College of Rheumatology Criteria for Treatment and Prevention of Glucocorticoid‐Induced Osteoporosis

Overman

Toliver

Yeh

et al. 2014

Arthritis Care & Research

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Objective. The American College of Rheumatology (ACR) updated its guidelines on the prevention and treatment of glucocorticoid-induced osteoporosis (GIO) in 2010. An unknown proportion of US adults at risk of fracture due to glucocorticoid use would be recommended antiosteoporosis pharmaceutical (AOP) therapies based on the ACR guidelines. Methods. Using the 2005-2010 National Health and Nutrition Examination Survey (NHANES) data for postmenopausal women (PMW), and men age >50 years reporting current glucocorticoid use, we categorized individuals according to ACR criteria for low, medium, and high fracture risk (<10%, >10%, and >20%, respectively) and provided percentages of treatment recommendations for chronic (>90 days) medium and all high-risk patients. Results. Glucocorticoids were used by 1.66% of PMW and 1.65% of men age >50 years. Of these patients, 0.80% of PMW and 0.45% of men age >50 years were at high risk of fracture. A majority of PMW (81.2%) and men age >50 years (75.8%) were chronic glucocorticoid users. In patients for whom treatment recommendations could be made, 64.9% of PMW and 51.9% of men age >50 years would be recommended therapy, but only 28.4% of PMW and 9.7% of men age >50 years reported AOP use. Conclusion. Based on the NHANES (2005-2010) data, we estimate glucocorticoid use in >1.5 million US PMW and men age >50 years. Treatment would be recommended in at least 50% of this population based on the 2010 ACR guidelines. Self-reported AOP use was documented in <30%, suggesting a treatment gap in the management of GIO in the US before the guideline release.

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confidence: 49%

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confidence: 99%

United States Adults Meeting 2010 American College of Rheumatology Criteria for Treatment and Prevention of Glucocorticoid‐Induced Osteoporosis

Overman

Toliver

Yeh

et al. 2014

Arthritis Care & Research

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“…A meta-analysis of 7 large prospective multinational cohorts showed that ever use of corticosteroids was associated with a 66% higher relative risk of osteoporotic fracture compared with never use of corticosteroids (5). The contribution of glucocorticoid use to osteoporosis has also been highlighted in several professional recommendations (24)(25)(26)(27). Conversely, in the context of chronic inflammatory disease, it may be that controlling inflammation can lower the risk of inflammatory bone loss.…”

Section: Effect Of Steroids and Tnf Inhibitors On Bmdmentioning

confidence: 99%

Meta‐Analysis of Tumor Necrosis Factor Inhibitors and Glucocorticoids on Bone Density in Rheumatoid Arthritis and Ankylosing Spondylitis Trials

Siu

Haraoui

Bissonnette

et al. 2015

Arthritis Care & Research

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Objective. To examine the impact of antirheumatic drugs on bone mineral density (BMD) in rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), and psoriasis using a systematic review. Methods. Electronic databases were systematically searched for randomized controlled trials. Studies were grouped based on disease, treatment, and site of BMD measurement. Change in BMD (DBMD) from baseline to end of study was recorded. Standardized mean difference (SMD) of DBMD between treatment and controls was standardized for meta-analyses and 95% confidence intervals (95% CIs) were calculated. Results. Treatment effects on BMD were not the primary outcomes of the trials. Thirteen studies were eligible (11 RA, 2 AS, 0 PsA, and 0 psoriasis). For RA, significantly less hand bone loss was seen with tumor necrosis factor inhibitors (TNFi; SMD DBMD 0.33 [95% CI 0.13, 0.53], P 5 0.001, I 2 5 0%) and glucocorticoids (SMD DBMD 0.51 [95% CI 0.20, 0.81], P 5 0.001, I 2 5 0%). TNFi had no significant effect on lumbar spine and hip BMD. Glucocorticoids were associated with a negative effect on lumbar spine (SMD DBMD 20.30 [95% CI 20.55,20.04], P 5 0.02, I 2 5 52%), but not hip BMD. For AS, a significant increase in BMD was seen with TNFi at the lumbar spine (SMD DBMD 0.96 [95% CI 0.64, 1.27], P < 0.001, I 2 5 16%) and hip (SMD DBMD 0.38 [95% CI 0.13, 0.62], P 5 0.003, I 2 5 0%). Data were insufficient to perform meta-analyses in PsA and psoriasis or for other antirheumatic drugs. Conclusion. In RA, TNFi and glucocorticoids appeared to attenuate hand bone loss. TNFi did not impact lumbar spine and hip BMD and glucocorticoids had negative effects on lumbar spine and no effect on hip BMD. In AS, TNFi was associated with improved lumbar spine and hip BMD.

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“…In 2012, the Joint IOF -European Calcified Tissue Society (ECTS) Glucocorticoid-induced Osteoporosis Guidelines Working Group published a framework for the development of guidelines for the management of GC-induced osteoporosis [94]. This comprehensive framework reviewed the epidemiology of GCinduced osteoporosis and fracture risk assessment based on 10-year probabilities ascertained from FRAX ® .…”

Section: Osteoporosis Induced By Medicinesmentioning

confidence: 99%

Mind the (treatment) gap: a global perspective on current and future strategies for prevention of fragility fractures

et al. 2017

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-none for this submission. EVM -none for this submission. JAK and PJM have undertaken consultancy for governments, national osteoporosis societies, healthcare professional organisations and private sector companies relating to systematic approaches to fragility fracture care and prevention. JYR has no disclosures related to this work, and has received consultancy, lecture fees and grant support from Amgen, Analis, Asahi Kasei, Boehringer, Bristol Myers Squibb, Chiltern, Danone, Ebewee Pharma, Endocyte, Galapagos, GlaxoSmithKline, IBSAGenevrier, Lilly, Merck Sharp and Dohme, Merckle, Negma, Novartis, NovoNordisk, NPS, Nycomed-Takeda, Organon, Pfizer, PharmEvo, Radius Health, Roche, Rottapharm, Servier, Teijin, Teva, Theramex, Therabel, UCB, Will Pharma, Wyeth, Zodiac. NCWH has no disclosures related to this work, and has received consultancy, lecture fees and honoraria from Alliance for Better Bone Health, AMGEN, MSD, Eli Lilly, Servier, Shire, Consilient Healthcare and Internis Pharma. PJM serves as a consultant to the International Osteoporosis Foundation and received remuneration for his contribution to this manuscript. RR has received honoraria for participation in Advisory boards or speaker bureau fees from Danone, Labatec, Nestlé, and ObsEva. Introduction-This narrative review considers the key challenges facing healthcare professionals and policymakers responsible for providing care to populations in relation to bone health. These challenges broadly fall into 4 distinct themes: Europe PMC Funders Group

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A framework for the development of guidelines for the management of glucocorticoid-induced osteoporosis

Abstract: Guidance for glucocorticoid-induced osteoporosis is updated in the light of new treatments and methods of assessment. National guidelines derived from this resource need to be tailored within the national healthcare framework of each country.

Cited by 304 publications

References 160 publications

United States Adults Meeting 2010 American College of Rheumatology Criteria for Treatment and Prevention of Glucocorticoid‐Induced Osteoporosis

United States Adults Meeting 2010 American College of Rheumatology Criteria for Treatment and Prevention of Glucocorticoid‐Induced Osteoporosis

Meta‐Analysis of Tumor Necrosis Factor Inhibitors and Glucocorticoids on Bone Density in Rheumatoid Arthritis and Ankylosing Spondylitis Trials

Mind the (treatment) gap: a global perspective on current and future strategies for prevention of fragility fractures

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