title: Guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis.
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 scientific evidence and/or expert experience.
  The bibliographic review of scientific 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 terms): Osteoporosis, Osteoporosis/ chemically induced*= (Glucocorticoids= Adrenal Cortex Hormones, Steroids), Glucocorticoids, Glucocorticoids/administration and dosage, Glucocorticoids/therapeutic use, Glucocorticoids/adverse effects, Prednisone/adverse effects, Dose-Response Relationship, Drug, Bone Density/drug effects, Bone Density Conservation Agents/pharmacological action, Osteoporosis/prevention & control, Calcium, Vitamin D, Vitamin D deficiency, Calcitriol, Receptors, Calcitriol; 1-hydroxycholecalciferol, Hydroxycholecalciferols, 25-Hydroxyvitamin D3 1-alpha-hydroxylase OR Steroid Hydroxylases, 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, Dual-Energy X-Ray Absorptiometry OR Absorptiometry Photon OR DXA, Densitometry, Radiography, (Diphosphonates Alendronate OR Risedronate Pamidronate OR propanolamines OR Ibandronate OR Zoledronic acid, Teriparatide OR PTH 1-34, Men AND premenopause, pregnancy, pregnancy outcome maternal, fetus, lactation, breast-feeding, teratogens, Children (6-12 years), adolescence (13-18 years).
  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.
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo 455, São Paulo, SP, Brazil. rosamariarp@yahoo.com
authors.forename: Rosa Maria Rodrigues
authors.initials: RM
authors.lastname: Pereira
authors.forename: Jozélio Freire de
authors.initials: JF
authors.lastname: Carvalho
authors.forename: Ana Patrícia
authors.initials: AP
authors.lastname: Paula
authors.forename: Cristiano
authors.initials: C
authors.lastname: Zerbini
authors.forename: Diogo S
authors.initials: DS
authors.lastname: Domiciano
authors.forename: Helenice
authors.initials: H
authors.lastname: Gonçalves
authors.forename: Jaime S
authors.initials: JS
authors.lastname: Danowski
authors.forename: João F
authors.initials: JF
authors.lastname: Marques Neto
authors.forename: Laura M C
authors.initials: LM
authors.lastname: Mendonça
authors.forename: Mailze C
authors.initials: MC
authors.lastname: Bezerra
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Terreri
authors.forename: Marta
authors.initials: M
authors.lastname: Imamura
authors.forename: Pedro
authors.initials: P
authors.lastname: Weingrill
authors.forename: Perola G
authors.initials: PG
authors.lastname: Plapler
authors.forename: Sebastião
authors.initials: S
authors.lastname: Radominski
authors.forename: Tatiana
authors.initials: T
authors.lastname: Tourinho
authors.forename: Vera L
authors.initials: VL
authors.lastname: Szejnfeld
authors.forename: Nathalia C
authors.initials: NC
authors.lastname: Andrada
mesh_terms: D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D010024:Osteoporosis / Q000139:chemically induced* / Q000517:prevention & control / Q000628:therapy*
chemical_list: D005938:Glucocorticoids