Threshold based on bone mineral density for therapeutic decision-making in postmenopausal women and men over 50 years old under glucocorticoid therapy

BRANCE, MARÍA LORENA; LARROUDÉ, MARÍA SILVIA; SOMMA, LUIS FERNANDO; GIACOIA, EVANGELINA; DIEHL, MARÍA; GALICH, ANA MARÍA; RAMIREZ STIEBEN, LUIS AGUSTÍN; MAHER, MARÍA CIELO; DE LA VEGA, MARÍA; RINGER, ARIANA; BRUN, LUCAS R.

Reumatología Clínica

Sociedad Española de Reumatología (SER) y del Colegio Mexicano de Reumatología (CMR)

Año: 2023

1699-258X

Introduction and aim: The T-score bone mineral density (BMD) thresholds might influence current guidance for treatment in patients under glucocorticoid (GC) therapy. Different BMD thresholds were described but there is no international consensus. The aim of this study was to find a threshold to help in the treatment decision in the population under GC therapy. Methods: A working group on behalf of three scientific societies from Argentina was convened. The first team was formed by specialists with expertise in glucocorticoid-induced osteoporosis (GIO) who voted according to summary of evidence. The second team was constituted by a methodology group who coordinated and supervised each stage. We conducted two systematic reviews to synthesize the evidence. The first included the trials of drugs used in GIO to analyze the BMD cut-off used as inclusion criteria. In the second one, we analyzed the evidence regarding the densitometric thresholds for fractured and non-fractured patients’ discrimination under GC treatment. Results: In the first revision, 31 articles were included for qualitative synthesis and more than 90% of the trials included patients regardless of the densitometric T-score or in the range of osteopenia. In the second revision, 4 articles were included and more than 80% of the T-scores were between the -1.6 and -2.0 range. The summary of findings was analyzed and subjected to voting. Conclusions: With an agreement over 80% of the voting expert panel, a T-score ≤ -1.7 was considered the most appropriate for treatment in postmenopausal women and men older than 50 years under GC therapy. This study could help in the treatment decision in patients under GC therapy without fractures but certainly should consider other risk of fractures.