Glucocorticoid-induced osteoporosis (GIO): What gio´s guideline is the more appropiate for prevention and treatment?

BRANCE ML; LARROUDÉ MS; KOHAN MP; CURTI AC; PEREZ CEPAS B; COSENTINO V; RIOS ACOSTA C; BRUN LR

Miami

Congreso; Congreso Panamericano de Reumatología 2020; 2020

PANLAR

GIO is the second cause after postmenopausal osteoporosis, and the most frequent of secondary osteoporosis. The guidelines of American College of Rheumatology (ACR), American Society of Bone and Mineral Research (ASBMR) and International Osteoporosis Foundation (IOF) show some differences to recommend treatment as: the age of the patients, the presence of a fragility fracture, low or high doses of glucocorticoids (GC), the stratification by FRAX tool, the presence of fracture risks; the time of GC. Aim: To compare the international GIO guidelines in patients with rheumatologic diseases treated with GC and the impact in the diagnosis and treatment.Patients and Methods. An observational, retrospective and descriptive study in patients ≥18 years old with rheumatologic diseases treated with GC was carried out. 500 clinical records were revised and only 283 patients were included in this study. Exclusion criteria: diagnosis of other autoimmune disease, malabsorption disease, hepatic or renal chronic failure, diabetes, other bone disease, patients with AIDS, tuberculosis, hypertiroidism or treated with anticonvulsivant. FRAX, and FRAX with GC correction was calculated in each patient which were classified according the different stratification of the three mention guidelines. With FRAX tool 17.6% of the patient couldn´t be analyzed because they were younger than 40 years old or they have got only lumbar spine BMD.Results. 85.8% women (14% premenopausal) and 14.2% men, mean age 57.1 (18-86) were included. According to WHO classification 29.6% had normal bone mineral density (BMD), 54% low BMD, and 16.4% osteoporosis. 18% of the patient had osteoporotic fractures: 22.9% in osteoporosis patients and 23.2% in low BMD patients. 13.1% had non-vertebral fractures (45% wrist, 16% hip, 39% others) and 20.1% had vertebral fractures which only 30% were symptomatic. 27.2% the patients has connective tissue diseases (vasculitis, ESL), 6.4% has seronegative spondiloarthropathies and 66.4% rheumatoid arthritis. After the analysis according the different GIO guidelines we found that with IOF recommendations 75.9% of the patients had not criteria for treatment, with ACR 2010 guidelines 47.7%, 32.1% with ASBMR 2011, and 68.9% according to ACR 2018. Therefore only 24.1% of the patients would be treated according IOF, 52.3% by ACR 2010, 67.9% by ASBMR 2011, and only 31.1% according ACR 2018. Conclusions. We found relevant difference in GIO guidelines. The limitation of FRAX in young patients, the need of fracture in young patients previous treatment, the consideration of Z-score ≤3, the long time period of control of the BMD are aspects that should be study to a better approach and avoid a fragility fracture in GIO.