Guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis: an update of Brazilian Society of Rheumatology (2020)

Pereira, Rosa Maria Rodrigues; Perez, Mariana Ortega; Paula, Ana; Moreira, Caio; Castro, Charlles Heldan de Moura; Zerbini, Cristiano A. F.; Domiciano, Diogo Souza; Azevedo, Elaine de; Mendonça, Laura Maria Carvalho de; Shinzato, Marcia Midore; Rocha-Loures, Marco Antônio; Radominski, Sebastião Cézar; Szejnfeld, Vera Lúcia

doi:10.1007/s11657-021-00902-z

Cited by 21 publications

(16 citation statements)

References 96 publications

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“…The mean number of relapses was 1.8 with a mean corticosteroid threshold at the time of relapse of 0.43 mg/kg/day. This threshold is higher than the one at which secondary effects on bone density and height occur (0.16 mg/kg/d prednisone) [24]. The PNDS (Protocole National de Diagnostic et de Soins) on nephrotic syndrome in children proposes different treatment durations for relapses, depending on their time of onset, but generally treatment duration of subsequent relapses is longer than for a first relapse [2].…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting the Statural Growth Retardation in Children using Steroids in Idiopathic Nephrotic Syndrome

Ndongo

Boiro

Basse³

et al. 2021

AJPR

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Background and Aim: Idiopathic nephrotic syndrome or nephrosis causes massive protein leakage in the urine. Its treatment requires steroids (prednisone, methylprednisolone), often for a prolonged period, notably in case of steroid-dependence or steroid-resistance. In children, long-term use of steroids can lead to several side effects such as statural growth retardation/ stunting. This study evaluated the frequency of stunting in idiopathic nephrotic syndrome in children on steroids and identified the associated factors. Material and Methods: This was a retrospective, descriptive cohort study carried out in children aged 0 to 16 years treated at the paediatric nephrology unit of Aristide Le Dantec Hospital in Dakar, between 1 December 2017 and 31 May 2020. All records of nephrotic children treated in outpatient or inpatient setting were included. These children had to be on corticosteroid therapy for at least 30 months and have a height taken regularly during follow-up consultations. Results: Of 259 children followed for idiopathic nephrotic syndrome, 93 were included in the study. The median age was 96.5 months and the sex ratio was 1.9. The mean height of the children at the beginning of the follow-up was -0.26 DS, at the end it was -0.88 DS. At the beginning of the follow-up, 8 children had already stunting. At 12 months follow-up, 72 children (77.4%) had a decrease in z-score; and at 30 months, there were 7 more children (84.9%) who had a decrease in z-score. Methylprednisolone boluses were given to 17 children (18.3%). Calcium supplementation was done in 91 children (97.8%). Vitamin D supplementation was given to 91 children (97.8%). The mean number of relapses was 1.8. Factors associated with stunting were number of relapses ≤3 (p=0.03), duration of corticosteroid therapy >6 months (p<0.0001) and cumulative doses of prednisone >100 mg/kg (p=0.04). Conclusion: In prolonged nephrotic syndrome in children, corticosteroids can cause stunting.

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Section: Discussionmentioning

confidence: 99%

Factors Affecting the Statural Growth Retardation in Children using Steroids in Idiopathic Nephrotic Syndrome

Ndongo

Boiro

Basse³

et al. 2021

AJPR

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“…The adverse effects of prolonged GC use on bone are well documented, with the most common cause of secondary osteoporosis being GC therapy [ 7 , 8 ]. The influence of GCs on bone seems to manifest initially as an increase in bone resorption within the first 5–7 months of treatment [ 9 ], whereas in the longer term, reduced bone formation is believed to be the primary driver of GC-induced bone loss [ 10 ].…”

Section: The Influence Of Gc Therapy On Bone and Skeletal Musclementioning

confidence: 99%

“…Notwithstanding the need for further investigation of the efficacy of calcium and/or vitamin D supplementation on bone health and fracture risk in individuals who undergo GC treatment, the importance of these micronutrients for bone health is clear, and maintaining adequate status should be a priority within nutritional plans (see Tables 1 and 2 ). Where possible, we recommend that all micronutrient requirements should be met primarily using a food-first approach and that nutrients should be obtained through whole foods rather than supplements [ 8 , 32 ] ( Table 2 ). The benefits of this approach are many.…”

Section: The Influence Of Gc Therapy On Bone and Skeletal Musclementioning

confidence: 99%

Nutritional recommendations for patients undergoing prolonged glucocorticoid therapy

Esteves¹,

Mazzolani²,

Smaira³

et al. 2022

Rheumatology Advances in Practice

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Glucocorticoid (GC) therapy is a common treatment employed in rheumatic and autoimmune diseases due to its anti-inflammatory and immunosuppressive effects. However, GC therapy can also induce a number of adverse effects, including muscle and bone loss, hypertension, metabolic perturbations and increased visceral adiposity. We reviewed available evidence in this area and provide nutritional recommendations that may ameliorate these adverse effects. Briefly, optimizing calcium, vitamin D, sodium and protein intake and increasing consumption of unprocessed and minimally processed foods, while decreasing the consumption of ultra-processed foods, may counteract some of the specific challenges faced by these patients. Importantly, we identified a dearth of empirical data of how nutritional intervention may impact health-related outcomes in this population and further research is required to investigate the clinical and therapeutic efficacy of these theory-based recommendations.

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“…The IOF/European Calcified Tissue Society framework, 106 the American College of Rheumatology guidelines, 107 the Malaysian 108 and Brazillian 109 guidelines recommend the use of FRAX® for risk stratification, 24 especially in older men and postmenopausal women. Japanese guidelines 110 provide a targeted risk stratification tool for their population.…”

Section: Denosumabmentioning

confidence: 99%

Challenges in the diagnosis and management of glucocorticoid‐induced osteoporosis in younger and older adults

Herath

Langdahl

Ebeling

et al. 2021

Clinical Endocrinology

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Objective Glucocorticoids constitute a considerable risk for developing osteoporosis in both younger and older adults. However, currently available bone imaging modalities and fracture‐risk assessment tools do not adequately capture the dramatic changes in bone microarchitecture, heterogeneity of glucocorticoid exposure, the impact of chronic disease and other osteoporosis risk factors on the assessment of osteoporosis in these individuals. Design A narrative review is presented, following a systematic search of the literature from 2000 to 2021. Results Our current appreciation of glucocorticoid‐induced osteoporosis (GIO) is focused on older populations, with limited evidence to guide the investigation, risk assessment and treatment in premenopausal women and men less than 50 years. The impact of the underlying chronic disease on secondary osteoporosis in these younger adults is also poorly understood. Conclusion Through this narrative review, we provide a comprehensive overview of and recommendations for optimising the management of this common cause of secondary osteoporosis younger and older adults.

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Guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis: an update of Brazilian Society of Rheumatology (2020)

Cited by 21 publications

References 96 publications

Factors Affecting the Statural Growth Retardation in Children using Steroids in Idiopathic Nephrotic Syndrome

Factors Affecting the Statural Growth Retardation in Children using Steroids in Idiopathic Nephrotic Syndrome

Nutritional recommendations for patients undergoing prolonged glucocorticoid therapy

Challenges in the diagnosis and management of glucocorticoid‐induced osteoporosis in younger and older adults

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