Pereira Rosa M R, Perez Mariana O, Paula Ana Patrícia, Moreira Caio, Castro Charlles H M, Zerbini Cristiano A F, Domiciano Diogo S, de Azevedo Elaine, Mendonca Laura M C, Shinzato Marcia Midore, da Rocha-Loures Marco Antonio A, Radominski Sebastião, Szejnfeld Vera L
Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3193, Sao Paulo, SP, 01246-903, Brazil.
Rheumatology Division, Faculdade de Ciências da Saúde, Universidade de Brasilia (UnB), Brasilia, DF, Brazil.
Arch Osteoporos. 2021 Mar 1;16(1):49. doi: 10.1007/s11657-021-00902-z.
The Brazilian guidelines for prevention and treatment of glucocorticoid-induced osteoporosis were updated and important topics were included such as assessment of risk fracture using FRAX Brazil, use of denosumab, and also recommendations for the use of glucocorticoid pulse therapy and inhaled glucocortiocoid.
Glucocorticoids (GCs) are used in almost all medical specialties and the incidences of vertebral/nonvertebral fractures range from 30 to 50% in individuals treated with GCs for over 3 months. Thus, osteoporosis and frailty fractures should be prevented and treated in patients initiating treatment or already being treated with GCs. The Committee for Osteoporosis and Bone Metabolic Disorders of the Brazilian Society of Rheumatology (BSR) established in 2012 the Brazilian Guidelines for glucocorticoid-induced osteoporosis (GIO). Herein, we provide a comprehensive update of the original guidelines based on improved available scientific evidence and/or expert experience.
From March to June 2020, the Osteoporosis Committee of the BRS had meetings to update the questions presented in the first consensus (2012). Thus, twenty-six questions considered essential for the preparation of the recommendations were selected. A systematic literature review based on real-life scenarios was undertaken to answer the proposed questions. The MEDLINE, EMBASE, and SCOPUS databases were searched using specific search keywords.
Based on the review and expert opinion, the recommendations were updated for each of the 26 questions. We included 48 new bibliographic references that became available after the date of the publication of the first version of the consensus.
We updated the Brazilian guidelines for the prevention/treatment of GIO. New topics were added in this update, such as the assessment of risk fracture using FRAX Brazil, the use of denosumab, and approaches for the treatment of children and adolescents. Furthermore, we included recommendations for the use of inhaled GCs and GC pulse therapy in clinical settings.
巴西糖皮质激素性骨质疏松症的预防和治疗指南进行了更新，纳入了重要主题，如使用巴西FRAX评估骨折风险、地诺单抗的使用，以及糖皮质激素脉冲疗法和吸入性糖皮质激素的使用建议。
糖皮质激素（GCs）几乎用于所有医学专科，接受GCs治疗超过3个月的个体中，椎体/非椎体骨折的发生率在30%至50%之间。因此，对于开始使用或已经在接受GCs治疗的患者，应预防和治疗骨质疏松症和脆性骨折。巴西风湿病学会（BSR）的骨质疏松症和骨代谢疾病委员会于2012年制定了巴西糖皮质激素性骨质疏松症（GIO）指南。在此，我们根据现有科学证据的改进和/或专家经验，对原始指南进行了全面更新。
2020年3月至6月，巴西风湿病学会骨质疏松症委员会召开会议，更新第一次共识（2012年）中提出的问题。因此，选择了26个被认为对制定建议至关重要的问题。基于实际情况进行了系统的文献综述，以回答提出的问题。使用特定的搜索关键词搜索MEDLINE、EMBASE和SCOPUS数据库。
基于综述和专家意见，对26个问题中的每一个都更新了建议。我们纳入了48篇在第一版共识发表日期之后才可用的新参考文献。
我们更新了巴西预防/治疗GIO的指南。本次更新增加了新主题，如使用巴西FRAX评估骨折风险、地诺单抗的使用，以及儿童和青少年的治疗方法。此外，我们还纳入了临床环境中吸入性GCs和GC脉冲疗法的使用建议。
