Letter to the Editor
Comments about treatment of glucocorticoid-induced osteoporosis
Comentarios sobre el tratamiento de la osteoporosis por corticoides
Osvaldo Daniel Messina
Corresponding author
IRO Centro Médico, Buenos Aires, Argentina
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The gray line and gray rhombs indicate the mean ESR and median prednisone dose respectively in every time point for the patients treated with methotrexate and prednisone. The black line and black rectangles indicate the mean ESR and median prednisone dose in every time point for patients treated with prednisone alone. Arrows indicate the time at which relapses occurred in both groups. As you can see, relapses were more frequent in the first year of treatment in both groups and were accompanied by a significant rise in the mean ESR value.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ines Perez-Sancristobal, Paula Alvarez-Hernandez, Cristina Lajas-Petisco, Benjamin Fernandez-Gutierrez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Ines" "apellidos" => "Perez-Sancristobal" ] 1 => array:2 [ "nombre" => "Paula" "apellidos" => "Alvarez-Hernandez" ] 2 => array:2 [ "nombre" => "Cristina" "apellidos" => "Lajas-Petisco" ] 3 => array:2 [ "nombre" => "Benjamin" "apellidos" => "Fernandez-Gutierrez" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574324000108?idApp=UINPBA00004M" "url" => "/21735743/0000002000000002/v1_202402220812/S2173574324000108/v1_202402220812/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Comments about treatment of glucocorticoid-induced osteoporosis" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "113" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Osvaldo Daniel Messina" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Osvaldo Daniel" "apellidos" => "Messina" "email" => array:1 [ 0 => "drosvaldodanielmessina@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "IRO Centro Médico, Buenos Aires, Argentina" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comentarios sobre el tratamiento de la osteoporosis por corticoides" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The reason for this letter is a number of comments related to the article on treatment thresholds in patients over 50 years of age by Brance et al., published in CLINICAL RHEUMATOLOGY in October 2022, which demonstrated multiple misconceptions regarding glucocorticoid-induced osteoporosis.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In our opinion, the most important of these are as follows:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1</span><p id="par0015" class="elsevierStylePara elsevierViewall">It is totally incorrect to set a threshold for treatment intervention based almost exclusively upon an arbitrary densitometric value, since glucocorticoids produce changes in bone structure in three dimensions, which cannot be measured with DXA as it is a planar method.</p></li></ul></p><p id="par0020" class="elsevierStylePara elsevierViewall">For this reason, at the same T-score value, the fracture rate in patients with corticoid-induced osteoporosis is twice that of patients with primary osteoporosis. Consequently, there are fractured patients with higher and even normal bone mineral density values vs. patients with primary osteoporosis. For this reason, basing treatment thresholds on bone mineral density values is a serious error which, in addition, shows ignorance of the biomechanical effects of corticosteroids on bone.<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2</span><p id="par0025" class="elsevierStylePara elsevierViewall">It is absolutely mandatory to incorporate FRAX, depending on the dose of corticosteroids used, since many other factors influence the risk of fracture.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3</span><p id="par0030" class="elsevierStylePara elsevierViewall">It is necessary to divide patients into those over and under 40 years of age. Patients under 40 years of age, for whom T-score values should not be used, cannot be disregarded.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4</span><p id="par0035" class="elsevierStylePara elsevierViewall">No modern clinical practice guidelines consider almost exclusively, as this article does, the T-score value (ACR 2017 guidelines updated in 2022, Latin American clinical practice guidelines from the International Osteoporosis Foundation [IOF] 2022 and the Brazilian <span class="elsevierStyleItalic">Guidas de Práctica Clínica 2020,</span> which are the most representative regional guidelines and were not referenced in this article).</p></li></ul></p><p id="par0040" class="elsevierStylePara elsevierViewall">We consider that this article leads to erroneous clinical and treatment behaviours, as it is incomplete in terms of treatment guidance in the management of patients treated with glucocorticoids. We suggest reading the recently published modern guidelines cited above.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–5</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evidence based Latin American Guuidelines of Clinical practice on prevention, diagnosis, management and treatment of glucocorticoid induced osteoporosis. 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