Diretrizes para prevenção e tratamento da osteoporose induzida por glicocorticoide

Abstract

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 Osteoporosis/prevention & control, Calcium, Vitamin D, Vitamin D defi ciency, Calcitriol, Receptors, Calcitriol; Hydroxycholecalciferols, 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, Densitometry, Radiography, (Diphosphonates Alendronate OR Risedronate Pamidronate OR propanolamines OR Ibandronate OR Zoledronic acid, Men AND premenopause, pregnancy, pregnancy outcome maternal, fetus, lactation, teratogens,, 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.

The Use of Bisphosphonates in Pediatrics

“…It frequently affects children with diffuse connective tissue diseases [21,22], inflammatory bowel diseases [23], chronic renal diseases [24,25], hematological malignancies [26,27,28,29], or solid tumors [30]. Systemic glucocorticoid treatment is associated with an initial increase in bone resorption and a subsequent reduction of bone formation, leading to decreased peak bone mass, microarchitectural deterioration and increased fracture risk [31,32,33,34]. There is good evidence that oral glucocorticoids, mainly when used for more than 3 months and at doses greater than 5-7.5 mg/day of prednisone (or equivalent), increase the risk of fragility fractures [31,32,33].…”

“…Systemic glucocorticoid treatment is associated with an initial increase in bone resorption and a subsequent reduction of bone formation, leading to decreased peak bone mass, microarchitectural deterioration and increased fracture risk [31,32,33,34]. There is good evidence that oral glucocorticoids, mainly when used for more than 3 months and at doses greater than 5-7.5 mg/day of prednisone (or equivalent), increase the risk of fragility fractures [31,32,33]. A recent systematic review and meta-analysis of glucocorticoid-induced osteoporosis in children reported incident clinical fracture rates from 2 to 33%.…”

Treinamento Resistido Na Retardação Do Processo De Sarcopenia Em Idosos

“…A primária divide-se em dois tipos: tipo I atinge as mulheres por estar associada à pós-menopausa pela diminuição abrupta na produção de estrogênio e atinge predominantemente o osso trabecular, e tipo II, associada ao envelhecimento, também conhecida como osteoporose senil, e aparece por deficiência crônica de cálcio. A secundária está relacionada a pessoas portadoras de doenças renais, endócrinas, hematológicas ou que fazem uso de alguns tipos de medicamentos 4,7,17 .…”

Avaliação de parâmetros do metabolismo ósseo e da saúde oral em pacientes com lúpus eritematoso sistêmico juvenil

“…Assim, o uso preventivo dessas suplementações, visa diminuir o impacto do uso dos GC sobre a densidade mineral óssea e o risco de fraturas 43 .…”