Letter to the Editor
Response to Letter to the Editor: Thresholds based on bone mineral density for therapeutic decision-making in postmenopausal women and men older than 50 years old under glucocorticoid therapy
Respuesta carta al editor: Umbrales densitométricos de densidad mineral ósea para considerar tratamiento en pacientes mujeres postmenopáusicas y hombres mayores de 50 años en tratamiento con glucocorticoides
María Lorena Brancea,b,c,
, María Silvia Larroudéd, Luis Fernando Sommae, Luis Agustín Ramirez Stiebena,b,f, Lucas R. Brunb,c
Corresponding author
a Reumatología y Enfermedades Óseas, Rosario, Argentina
b Bone Biology Laboratory, School of Medicine, Rosario National University, Argentina
c National Council of Scientific and Technical Research (CONICET), Argentina
d Centro Rossi, Buenos Aires, Argentina
e Consultorio de Reumatologia y Osteoporosis, Lujan, Argentina
f Hospital Privado de Rosario (Grupo Gamma), Rosario, Argentina
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"apellidos" => "Brun" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Reumatología y Enfermedades Óseas, Rosario, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Bone Biology Laboratory, School of Medicine, Rosario National University, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "National Council of Scientific and Technical Research (CONICET), Argentina" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Centro Rossi, Buenos Aires, Argentina" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Consultorio de Reumatologia y Osteoporosis, Lujan, Argentina" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Hospital Privado de Rosario (Grupo Gamma), Rosario, Argentina" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta carta al editor: Umbrales densitométricos de densidad mineral ósea para considerar tratamiento en pacientes mujeres postmenopáusicas y hombres mayores de 50 años en tratamiento con glucocorticoides" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We thank the Editors for allowing us to respond to the letter to the editor about our recently published article in <span class="elsevierStyleItalic">Reumatología Clínica</span> titled “Threshold based on bone mineral density for therapeutic decision-making in postmenopausal women and men over 50 years old under glucocorticoid therapy.”</p><p id="par0010" class="elsevierStylePara elsevierViewall">In addition, we thank the author of the letter to the editor for his interest in this article.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The PICO questions from Guidelines for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis were developed by a prestigious expert panel on behalf of the three national societies from Argentina linked to bone metabolism and are intended to provide an evidence-based framework to guide health care professionals treating patients under glucocorticoid therapy. The involved societies consider adherence to the recommendations within this guideline to be voluntary, with the decision regarding their application to be made by the physician according to each patient's circumstances. Guidelines and recommendations are intended to promote beneficial or desirable outcomes but cannot guarantee any specific outcome and cannot adequately all circumstances.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In these guidelines all the authors agreed to stratify the populations in premenopausal women and men<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>50 years; postmenopausal women and men aged 50 and older, and pediatrics.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Dr. Messina refer that “no modern clinical practice guideline considers the <span class="elsevierStyleItalic">T</span>-score value almost exclusively like this article”. First, we do not consider the <span class="elsevierStyleItalic">T</span>-score exclusively, we invite you to read our article carefully. Second, many guidelines listed below have historically defined <span class="elsevierStyleItalic">T</span>-score arbitrarily.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3–7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Further, the guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis: an update of Brazilian Society of Rheumatology (2020), recommends for example a <span class="elsevierStyleItalic">T</span>-score for prevention and treatment in men: “Recommendation: For prevention, we consider a <span class="elsevierStyleItalic">T</span>-score<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>−1 SD for men, and for treatment, a <span class="elsevierStyleItalic">T</span>-score<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>−1.89 SD is considered (A)”.</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">T</span>-score threshold of ≤−1.7 by DXA, was not arbitrarily chosen, as was described in methodology section. But is important to highlight that this article only consider the methodological procedure that explain why <span class="elsevierStyleItalic">T</span>-score<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>1.7 was chosen as threshold based on BMD for therapeutic decision-making in postmenopausal women and men over 50 years old under glucocorticoid therapy.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> In the Guidelines previously published you can find all the reasons – including FRAX – explained in detail, beyond the densitometric threshold.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Finally, we did not include some references because, as the author of the editor's letter should have noted, the guideline included systematic literature searches up to October 2020. The articles mentioned as not quoted were published after (Pereira RMR, et al. Arch Osteoporos. 2021 Mar 1;16(1):49 and Messina OD, et al. Aging Clin Exp Res. 2022 Nov;34(11):2591–2602). Further, the article by Messina OD was published after (2022 November) we submitted our article (2022 August).</p><p id="par0045" class="elsevierStylePara elsevierViewall">We respect the opinion, but it should be noted that the published guidelines and recommendations were developed by a group of experts on behalf of the three national scientific societies linked to bone metabolism: AAOMM (Argentinean Association of Osteology and Mineral Metabolism), SAO (Argentinean Osteoporosis Society) and SAR (Argentinean Rheumatology Society). In addition, the guidelines were carried out according to GRADE methodology, they were submitted to external review by prestigious experts in bone diseases, in addition to peer review carried out by each journal.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors’ contribution</span><p id="par0050" class="elsevierStylePara elsevierViewall">All authors read, discussed, and approved the final manuscript.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">No conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Authors’ contribution" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Argentine guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis in postmenopausal women and men aged 50 years and older" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.L. 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