array:23 [
  "pii" => "S1699258X22002297"
  "issn" => "1699258X"
  "doi" => "10.1016/j.reuma.2022.10.002"
  "estado" => "S300"
  "fechaPublicacion" => "2023-05-01"
  "aid" => "1652"
  "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología"
  "copyrightAnyo" => "2022"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Reumatol Clin. 2023;19:279-84"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S1699258X2200184X"
    "issn" => "1699258X"
    "doi" => "10.1016/j.reuma.2022.08.006"
    "estado" => "S300"
    "fechaPublicacion" => "2023-05-01"
    "aid" => "1645"
    "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Reumatol Clin. 2023;19:285-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
      "titulo" => "Trichorhinophalangeal syndrome type 1 &#40;Giedion syndrome&#41;&#58; A case report with literature review"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "285"
          "paginaFinal" => "289"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "S&#237;ndrome tricorrinofal&#225;ngico tipo 1 &#40;s&#237;ndrome de Giedion&#41;&#58; caso cl&#237;nico y revisi&#243;n de la literatura"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Fig&#46; 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 936
              "Ancho" => 1674
              "Tamanyo" => 178523
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Intraoral view of the patient &#40;1 week after surgery&#41;&#46; &#40;A&#41; Anterior open-bite with dental crowding&#59; &#40;B&#41; high-arched palate&#59; &#40;C and D&#41; bilateral posterior cross-bite with dental crowding&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Canseda Ava&#287;, Selen Adilo&#287;lu, Murat Akkocao&#287;lu"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Canseda"
              "apellidos" => "Ava&#287;"
            ]
            1 => array:2 [
              "nombre" => "Selen"
              "apellidos" => "Adilo&#287;lu"
            ]
            2 => array:2 [
              "nombre" => "Murat"
              "apellidos" => "Akkocao&#287;lu"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X2200184X?idApp=UINPBA00004M"
    "url" => "/1699258X/0000001900000005/v1_202304271842/S1699258X2200184X/v1_202304271842/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1699258X22001838"
    "issn" => "1699258X"
    "doi" => "10.1016/j.reuma.2022.08.005"
    "estado" => "S300"
    "fechaPublicacion" => "2023-05-01"
    "aid" => "1644"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Reumatol Clin. 2023;19:273-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "es" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
      "titulo" => "Necesidades&#44; impacto y perspectiva actual de los pacientes con espondiloartritis incluyendo la artritis psori&#225;sica"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "273"
          "paginaFinal" => "278"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Patients with spondyloarthritis including psoriatic arthritis&#58; Current needs&#44; impact&#44; and perspective"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Est&#237;baliz Loza, Pedro Plazuelo,  Ceade"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Est&#237;baliz"
              "apellidos" => "Loza"
            ]
            1 => array:2 [
              "nombre" => "Pedro"
              "apellidos" => "Plazuelo"
            ]
            2 => array:1 [
              "apellidos" => "Ceade"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S217357432300062X"
        "doi" => "10.1016/j.reumae.2022.08.006"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357432300062X?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X22001838?idApp=UINPBA00004M"
    "url" => "/1699258X/0000001900000005/v1_202304271842/S1699258X22001838/v1_202304271842/es/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Threshold based on bone mineral density for therapeutic decision-making in postmenopausal women and men over 50 years old under glucocorticoid therapy"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "279"
        "paginaFinal" => "284"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Mar&#237;a Lorena Brance, Mar&#237;a Silvia Larroud&#233;, Luis Fernando Somma, Evangelina Giacoia, Mar&#237;a Diehl, Ana Mar&#237;a Galich, Luis Agust&#237;n Ramirez Stieben, Mar&#237;a Cielo Maher, Mar&#237;a De La Vega, Ariana Ringer, Lucas R&#46; Brun"
        "autores" => array:11 [
          0 => array:4 [
            "nombre" => "Mar&#237;a Lorena"
            "apellidos" => "Brance"
            "email" => array:1 [
              0 => "lorenabrance@gmail.com"
            ]
            "referencia" => array:4 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Mar&#237;a Silvia"
            "apellidos" => "Larroud&#233;"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Luis Fernando"
            "apellidos" => "Somma"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Evangelina"
            "apellidos" => "Giacoia"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Mar&#237;a"
            "apellidos" => "Diehl"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "aff0035"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Ana Mar&#237;a"
            "apellidos" => "Galich"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "aff0035"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Luis Agust&#237;n"
            "apellidos" => "Ramirez Stieben"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">h</span>"
                "identificador" => "aff0040"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Mar&#237;a Cielo"
            "apellidos" => "Maher"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">i</span>"
                "identificador" => "aff0045"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Mar&#237;a"
            "apellidos" => "De La Vega"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">j</span>"
                "identificador" => "aff0050"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "Ariana"
            "apellidos" => "Ringer"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">k</span>"
                "identificador" => "aff0055"
              ]
            ]
          ]
          10 => array:3 [
            "nombre" => "Lucas R&#46;"
            "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:11 [
          0 => array:3 [
            "entidad" => "Reumatolog&#237;a y Enfermedades &#211;seas&#44; Rosario&#44; Argentina"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Bone Biology Laboratory&#44; School of Medicine&#44; Rosario National University&#44; Argentina"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "National Council of Scientific and Technical Research &#40;CONICET&#41;&#44; Argentina"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Centro Rossi&#44; Buenos Aires&#44; Argentina"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Consultorio de Reumatologia y Osteoporosis&#44; Lujan&#44; Argentina"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
          5 => array:3 [
            "entidad" => "Hospital Nacional Prof&#46; A&#46; Posadas&#44; Buenos Aires&#44; Argentina"
            "etiqueta" => "f"
            "identificador" => "aff0030"
          ]
          6 => array:3 [
            "entidad" => "Hospital Italiano de Buenos Aires&#44; Buenos Aires&#44; Argentina"
            "etiqueta" => "g"
            "identificador" => "aff0035"
          ]
          7 => array:3 [
            "entidad" => "Hospital Privado de Rosario &#40;Grupo Gamma&#41;&#44; Rosario&#44; Argentina"
            "etiqueta" => "h"
            "identificador" => "aff0040"
          ]
          8 => array:3 [
            "entidad" => "Instituto de Rehabilitaci&#243;n Psicof&#237;sica &#40;IREP&#41;&#44; Buenos Aires&#44; Argentina"
            "etiqueta" => "i"
            "identificador" => "aff0045"
          ]
          9 => array:3 [
            "entidad" => "Ceim Investigaciones M&#233;dicas&#44; Buenos Aires&#44; Argentina"
            "etiqueta" => "j"
            "identificador" => "aff0050"
          ]
          10 => array:3 [
            "entidad" => "Hospital Provincial del Centenario&#44; Rosario&#44; Argentina"
            "etiqueta" => "k"
            "identificador" => "aff0055"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Umbral densitom&#233;trico de densidad mineral &#243;sea para considerar tratamiento en pacientes mujeres posmenop&#225;usicas y hombres mayores de 50 a&#241;os en tratamiento con glucocorticoids"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 4167
            "Ancho" => 1694
            "Tamanyo" => 504563
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flowcharts of both systematic review&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Bone mineral density &#40;BMD&#41; measured by dual X-ray absorptiometry &#40;DXA&#41; is the current gold standard reference for the diagnosis of osteoporosis&#46; Since BMD is one of the strongest predictors of fracture risk&#44; many agencies worldwide have adopted BMD-based criteria as intervention thresholds&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">1</span></a> According to existing guidelines for postmenopausal women&#44; a <span class="elsevierStyleItalic">T</span>-score of &#8722;2&#46;5 SD or lower is recommended to offer treatment in those patients without fragility fractures&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">2</span></a> The <span class="elsevierStyleItalic">T</span>-score BMD thresholds might influence current guidance for treatment in patients under glucocorticoid &#40;GC&#41; therapy&#46; Different BMD thresholds were described throughout the time&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">3&#8211;9</span></a> Several differences exist between the 2001 and 2010 American College of Rheumatology &#40;ACR&#41; glucocorticoid-induced osteoporosis &#40;GIO&#41; guidelines&#46; In 2001&#44; the ACR guideline recommended treatment for GIO in any patient with a <span class="elsevierStyleItalic">T</span>-score below &#8722;1&#46;0&#46; On the other hand&#44; in 2010 the treatment was suggested considering the low&#44; moderate&#44; or high-risk of fracture&#46; The ASBMR-PPC &#40;American Society for Bone and Mineral Research-Professional Practice Committee&#41; also stratified postmenopausal women and men<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>50 years into low&#44; medium&#44; and high risk of fracture according to FRAX score&#46; For patients who had low risk but have an indication for prednisone &#62;7&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#44; the recommendation is to indicate treatment but for those with lower GC doses&#44; the suggestion is to monitor the patient with BMD&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">6</span></a> In 2012&#44; the IOF-ECTS GIO Guidelines Working Group defined a BMD <span class="elsevierStyleItalic">T</span>-score lower than &#8722;1&#46;5 as one of the indications for bone-protective therapy in postmenopausal women and men &#8805;50 years under GC therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">7</span></a> The Japanese guidelines also consider it as a cut-off value of BMD in around 80&#37; of the young adult population&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">10</span></a> The ACR guideline 2017 recommended initial pharmacologic treatment in adults<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>40 years of age who are at moderate-to-high risk of fracture considering high-risk to those with <span class="elsevierStyleItalic">T</span>-score<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#8722;2&#46;5&#44; by FRAX GC-adjusted or with a prior fragility fracture&#46; Recently&#44; the 2020 GIO Brazilian guidelines recommended a <span class="elsevierStyleItalic">T</span>-score<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#8722;1&#46;89 for treatment in men&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">8</span></a> Consequently&#44; there is no international consensus regarding the BMD cut-off for diagnosis and treatment in GIO&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Therefore&#44; in the context of the development of Argentine guidelines for prevention and treatment of GIO&#44; a working group on behalf of three scientific societies from Argentina&#58; AAOMM &#40;<span class="elsevierStyleItalic">Asociaci&#243;n Argentina de Osteolog&#237;a y Metabolismo Mineral</span> &#8211; Argentine Association of Osteology and Mineral Metabolism&#41;&#44; SAO &#40;<span class="elsevierStyleItalic">Sociedad Argentina de Osteoporosis</span> &#8211; Argentine Osteoporosis Society&#41; and SAR &#40;<span class="elsevierStyleItalic">Sociedad Argentina de Reumatolog&#237;a</span> &#8211; Argentine Society of Rheumatology&#41; was convened to identify areas of consensus among a panel of experts&#44; with the aim of discussing the available data for the threshold based on BMD for therapeutic decision-making in postmenopausal and men<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>50 years under GC therapy&#46; In the absence of a consensus about a cut-off for the diagnosis of GIO&#44; there is a risk of not identifying those patients who&#44; under GC therapy&#44; are at risk of fragility fracture&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Objective</span><p id="par0015" class="elsevierStylePara elsevierViewall">The overall aim of this study was to find a threshold according to the reported evidence to be able to help in the treatment decision in the population under GC therapy&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Development teams</span><p id="par0020" class="elsevierStylePara elsevierViewall">This work involved a working group on behalf of three scientific societies from Argentina&#58; AAOMM&#44; SAO and SAR&#46; An equal number of participants was selected by each society according to its expertise&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The first team was formed by specialists &#40;rheumatologists&#44; endocrinologists&#44; internists&#44; physiatrists&#41; with expertise and clinical experience in treating GIO and bone diseases&#46; The second team was constituted by a methodology group who coordinated and supervised each stage of the work and conducted the literature search and data abstraction&#44; rated the quality of evidence&#44; analyzed the data&#44; and created the tables of summary of findings&#46; In the framework of two virtual meetings&#44; the methodology and summary of findings of the two systematic reviews were shown to the voting expert panel who discuss about the threshold based on BMD for therapeutic decision-making in postmenopausal and men<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>50 years under GC therapy&#46; The voting expert panel voted both diagnostic questions requiring 70&#37; agreement among the voting members&#46; Diagnostic questions&#58; 1&#46; What was the densitometric threshold used as inclusion criteria in the population treated with GC in the trials that studied drugs for GIO&#63; 2&#46; What would be the best densitometric threshold that discriminates among fractures and non fractures in patient under GC treatment&#63;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Systematic reviews</span><p id="par0030" class="elsevierStylePara elsevierViewall">Two systematic reviews were performed &#40;<a class="elsevierStyleCrossRef" href="#sec0095">Appendix 1</a>&#41;&#46; In the first systematic review the literature was searched for key terms until October 2020&#44; using the databases of MEDLINE &#40;National Library of Medicine&#41; &#40;<a href="https://pubmed.ncbi.nlm.nih.gov/">https&#58;&#47;&#47;pubmed&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;</a>&#41;&#44; Cochrane Library &#40;<a href="https://www.cochranelibrary.com/">https&#58;&#47;&#47;www&#46;cochranelibrary&#46;com&#47;</a>&#41; and LILACS &#40;<a href="https://lilacs.bvsalud.org/es/">https&#58;&#47;&#47;lilacs&#46;bvsalud&#46;org&#47;es&#47;</a>&#41;&#44; and grey literature in the last 5 years&#46; This review was performed in the context of the development of Argentine guidelines for prevention and treatment of GIO under PICO structure&#46; In this first review&#44; the focus was to evaluate the <span class="elsevierStyleItalic">T</span>-score cut-off used in the trials that evaluated pharmacological intervention in GIO&#46; In the second systematic review&#44; the literature was searched for key terms until February 2022 and aimed to search for evidence about the BMD <span class="elsevierStyleItalic">T</span>-score threshold that discriminates between fractured and non-fractured populations&#46; An expert panel reviewed the included studies selected in both systematic reviews&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Eligibility criteria</span><p id="par0035" class="elsevierStylePara elsevierViewall">We included randomized controlled trials&#44; non-randomized trials&#44; post hoc analysis and pooled analysis in postmenopausal women and men older than 50 years old&#44; in which the <span class="elsevierStyleItalic">T</span>-score BMD baseline was reported studying a pharmacological treatment in patients under GC therapy &#40;&#8805;5<span class="elsevierStyleHsp" style=""></span>mg&#47;day prednisolone or equivalent&#41; regardless of GC administration time&#46; <span class="elsevierStyleItalic">T</span>-scores BMD in the lumbar spine &#40;LS&#41; or total hip &#40;TH&#41;&#44; thresholds <span class="elsevierStyleItalic">T</span>-scores BMD values were considered as outcomes&#46; Only articles in English&#44; Portuguese and Spanish were included&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Case reports&#44; reviews&#44; letters to the editor&#44; animal studies&#44; editorials&#44; commentaries&#44; other languages than the described previously&#44; and if identical data were re-analyzed were considered as exclusion criteria&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Study selection</span><p id="par0045" class="elsevierStylePara elsevierViewall">Rayyan software &#40;<a href="https://rayyan-prod.qcri.org/welcome">https&#58;&#47;&#47;rayyan-prod&#46;qcri&#46;org&#47;welcome</a>&#41; was used to screen the literature search results&#46; Two independent reviewers performed the title and abstract screening and then underwent full-text screening&#46; A third reviewer was included in case of conflicts&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The data extraction and processing were obtained by two authors independently using a standardized data extraction&#58; authors&#44; study design&#44; participants&#44; age of participants&#44; time and dose of GC&#44; diagnostic used for osteoporosis&#44; baseline <span class="elsevierStyleItalic">T</span>-score value in each group&#44; intervention&#44; comparator&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The quality assessment and publication bias of randomized controlled trials were judged using the Cochrane risk of bias tool &#40;<a href="http://handbook.cochrane.org/">http&#58;&#47;&#47;handbook&#46;cochrane&#46;org&#47;</a>&#41;&#46; For non-randomized controlled trials&#44; the assessment was performed using the Newcastle&#8211;Ottawa scale &#40;NOS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">11</span></a> For cross-sectional studies&#44; we used a modified version of NOS and studies that received at least seven stars &#40;maximum of ten&#41; were classified as good quality&#46; The PRISMA-P guideline was used to prepare this systematic review&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">12&#44;13</span></a></p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Qualitative synthesis&#46; Description of studies</span><p id="par0060" class="elsevierStylePara elsevierViewall">The studies were divided into two parts according to each search&#58; Part 1 included the trials of drugs used in GIO&#44; while Part 2 included BMD thresholds for fractured and non-fractured patients&#8217; discrimination under GC therapy&#46; The flowcharts of both systematic reviews are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#44; and the quality assessment of the studies is in <a class="elsevierStyleCrossRef" href="#sec0095">Appendix 2</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Part 1</span><p id="par0065" class="elsevierStylePara elsevierViewall">In this first revision&#44; a total of 1214 selected articles were found&#46; A total of 31 articles were included for qualitative synthesis and we stratify the trials according to the densitometric <span class="elsevierStyleItalic">T</span>-score used as inclusion criteria in each trial&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">14&#8211;44</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The summary of the studies characteristics is shown in <a class="elsevierStyleCrossRef" href="#sec0095">Appendix 3</a>&#46; The 93&#46;7&#37; of the trials included patients regardless of the densitometric <span class="elsevierStyleItalic">T</span>-score or in the range of osteopenia &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Part 2</span><p id="par0075" class="elsevierStylePara elsevierViewall">In this second revision a total of 54 selected articles were found and 4 articles were included&#46;<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">45&#8211;48</span></a> More than 80&#37; of the <span class="elsevierStyleItalic">T</span>-scores were between the &#8722;1&#46;6 and &#8722;2&#46;0 range &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Expert panel consensus</span><p id="par0080" class="elsevierStylePara elsevierViewall">After analyzing the evidence from both systematic reviews&#44; the expert panel discussed in meetings in the framework of a working group with experts in bone diseases&#46; The expert panel voted on the threshold of the BMD <span class="elsevierStyleItalic">T</span>-score that best identifies fractured from the non-fractured population&#46; Taking into account that more than 90&#37; of the trials about GIO included patients regardless of the densitometric <span class="elsevierStyleItalic">T</span>-score or in the range of osteopenia&#44; and more than 80&#37; of the <span class="elsevierStyleItalic">T</span>-scores that discriminates between fractured and non-fractured patients are within &#8722;1&#46;6 and &#8722;2&#46;0&#44; the voting was performed among this range&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">With an agreement over 80&#37; of the voting expert panel&#44; a <span class="elsevierStyleItalic">T</span>-score<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#8722;1&#46;7 was considered the most appropriate for treatment in postmenopausal women and men older than 50 years under GC therapy&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">T</span>-score BMD thresholds might influence current guidance for treatment in patients under GC treatment&#46; Several published guidelines for GIO management demonstrate large differences in the thresholds in patients under GC treatment as were previously detailed&#46; In GIO there is no international consensus regarding the most appropriate BMD threshold for treatment&#46; Therefore&#44; we considered conducting this systematic review in the context of the development of Argentine guidelines for prevention and treatment of glucocorticoid-induced osteoporosis by 3 scientific societies from Argentina to determine the most appropriate BMD <span class="elsevierStyleItalic">T</span>-score threshold to help in the GIO treatment decision&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">As far as we know&#44; the thresholds are noy ideal from every perspective and there is no <span class="elsevierStyleItalic">T</span>-score BMD threshold gold standard established by international consensus in GIO&#46; At the same time&#44; the fracture incidence differs markedly in different regions of the world&#44; accordingly to ethnicity among other variables&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">49</span></a> Despite it being suggested that each country should determine their own intervention thresholds&#44; based on fracture incidence&#44; availability of resources&#44; and economic considerations&#44; these data are not always available&#46; Therefore&#44; the fracture risk assessment tool &#40;FRAX&#41; was developed to estimate the 10-year probability of fractures&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">50</span></a> Dawson-Hughes et al&#46; identified cost-effective intervention thresholds based on 10-year absolute hip fracture risk&#46; With BMD in osteopenia levels &#40;<span class="elsevierStyleItalic">T</span>-score &#8722;2&#46;0&#41; plus a clinical risk factor&#44; the absolute fracture probability estimate meets or exceeds the 3&#37; cost-effectiveness threshold in all instances&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">51</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Previous studies have evaluated BMD thresholds for discrimination of fractured and non-fractured patients under GC therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">45&#8211;48</span></a> Kaji et al&#46; analyzed the threshold of BDM for vertebral fracture in Japanese female patients with GIO&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">48</span></a> The cut-off values of BMD which discriminates patients with vertebral fractures from those without vertebral fractures were higher in patients with GC treatment&#46; They found a cut-off for vertebral fracture of &#8722;1&#46;88 in lumbar spine BMD &#40;sensitivity and specificity 61&#46;5&#37;&#41; and &#8722;1&#46;67 in femoral neck BMD &#40;sensitivity and specificity 70&#46;9&#37;&#41;&#46; Nawata et al&#46;&#44; in the context of the GIO Japanese guidelines&#44; described the results of a longitudinal study in which the BMD <span class="elsevierStyleItalic">T</span>-score cut-off was discriminated between fractures and non-fractures&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">46</span></a> Considering the whole GC treated group &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>692&#41;&#44; the cut-off found was a <span class="elsevierStyleItalic">T</span>-score of &#8722;1&#46;97&#46; Van Staa TP et al&#46;&#44; after analyzing data from 2 large&#44; prospective&#44; randomized controlled trials &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>306&#41; showed that the daily GC dose&#44; and not the cumulative dose&#44; is a strong predictor of the risk of vertebral fracture in postmenopausal women under GC therapy&#44; at similar baseline levels of BMD&#46; They described a <span class="elsevierStyleItalic">T</span>-score threshold of &#8722;1&#46;8 for the lumbar spine and &#8722;1&#46;9 for femoral neck BMD&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">45</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In summary&#44; the voting expert panel selected a BMD <span class="elsevierStyleItalic">T</span>-score<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#8722;1&#46;7 as the most appropriate for help in the treatment decision in postmenopausal women and men older than 50 years under GC therapy&#46; This agreement was reached after prolonged discussion and debate&#46; Lower <span class="elsevierStyleItalic">T</span>-scores were not selected because lack of evidence was considered and to avoid overtreatment even when there is not enough data on the different ethnic groups and populations&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">One of the limitations of this paper is that the analysis is based on indirect data from systematic reviews and most data come from the Japanese population&#46; However&#44; two exhaustive systematic reviews were conducted&#44; addressing the problem from two perspectives as a strength&#46; Therefore&#44; longitudinal studies according to age&#44; gender and ethnicity are needed to identify the optimal BMD threshold&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusions</span><p id="par0115" class="elsevierStylePara elsevierViewall">With an agreement over 80&#37; of the voting expert panel&#44; a <span class="elsevierStyleItalic">T</span>-score<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#8722;1&#46;7 was considered the most appropriate for treatment in postmenopausal women and men older than 50 years under GC therapy&#46; This study could help in the treatment decision in patients under GC therapy without fractures but certainly should consider other concepts as age&#44; sex&#44; fracture history&#44; risk fracture stratification&#44; FRAX&#44; among others&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Authors&#8217; contribution</span><p id="par0120" class="elsevierStylePara elsevierViewall">MLB&#58; study design and scope of these systematic reviews&#46; MLB&#44; MSL&#44; LFS&#44; EG&#44; MD&#44; AMG&#44; LARS&#44; MDLV&#58; voting expert panel&#46; MLB&#44; AR&#44; LARS&#44; CM&#44; LRB&#58; performed the systematic review&#46; MLB and LRB&#58; drafting of the manuscript&#46; All authors read&#44; discussed&#44; and approved the final manuscript&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Financial support</span><p id="par0125" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflict of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">Maria Lorena Brance received lecture fees from Amgen and Craveri and fees as an advisory board from Amgen&#46; Mar&#237;a Silvia Larroud&#233; received lecture fees from Pfizer&#44; Lilly&#44; Amgen&#44; Astrazeneca and Genzyme Sanofi&#46; Evangelina Giacoia received lecture fees and fees as an advisory board from Amgen&#46; Mar&#237;a Diehl received research support from Amgen&#46; Ana Mar&#237;a Galich received lecture fees from Raffo&#44; Amgen and Eli Lilly&#46; Luis Fernando Somma&#44; Luis Agust&#237;n Ramirez Stieben&#44; Mar&#237;a Cielo Maher&#44; Maria Celina de la Vega&#44; Ariana Ringer&#44; and Lucas R Brun reported no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:14 [
        0 => array:3 [
          "identificador" => "xres1891016"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction and aim"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1636463"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1891017"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introducci&#243;n y objetivo"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1636464"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Objective"
        ]
        6 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Methods"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Development teams"
            ]
            1 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Systematic reviews"
            ]
            2 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Eligibility criteria"
            ]
            3 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Study selection"
            ]
          ]
        ]
        7 => array:3 [
          "identificador" => "sec0040"
          "titulo" => "Results"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Qualitative synthesis&#46; Description of studies"
            ]
            1 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Part 1"
            ]
            2 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Part 2"
            ]
            3 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Expert panel consensus"
            ]
          ]
        ]
        8 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Discussion"
        ]
        9 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Conclusions"
        ]
        10 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Authors&#8217; contribution"
        ]
        11 => array:2 [
          "identificador" => "sec0080"
          "titulo" => "Financial support"
        ]
        12 => array:2 [
          "identificador" => "sec0085"
          "titulo" => "Conflict of interest"
        ]
        13 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2022-08-02"
    "fechaAceptado" => "2022-10-20"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1636463"
          "palabras" => array:5 [
            0 => "Glucocorticoids"
            1 => "Osteoporosis"
            2 => "Treatment"
            3 => "Bone mineral density"
            4 => "Thresholds"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1636464"
          "palabras" => array:5 [
            0 => "Glucocorticoides"
            1 => "Osteoporosis"
            2 => "Tratamiento"
            3 => "Densidad mineral &#243;sea"
            4 => "Umbrales"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and aim</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">T</span>-score bone mineral density &#40;BMD&#41; thresholds may influence guidance for treatment in patients under glucocorticoid &#40;GC&#41; therapy&#46; Different BMD thresholds have been described but there is no international consensus&#46; The aim of this study was to find a threshold to help in treatment decision-making in the population under GC therapy&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A working group representing three scientific societies from Argentina was convened&#46; The first team was formed by specialists with expertise in glucocorticoid-induced osteoporosis &#40;GIO&#41; who voted according to summary of evidence&#46; The second team was constituted by a methodology group who coordinated and supervised each stage&#46; We conducted two systematic reviews to synthesize the evidence&#46; The first included trials of drugs used in GIO to analyze the BMD cut-off used as inclusion criteria&#46; In the second&#44; we analyzed the evidence regarding the densitometric thresholds to discriminate between fractured and non-fractured patients under GC treatment&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In the first review&#44; 31 articles were included for qualitative synthesis and more than 90&#37; of the trials included patients regardless of their densitometric <span class="elsevierStyleItalic">T</span>-score or range of osteopenia&#46; In the second review&#44; 4 articles were included and more than 80&#37; of the <span class="elsevierStyleItalic">T</span>-scores were in the range &#8722;1&#46;6 to &#8722;2&#46;0&#46; The summary of findings was analyzed and put to a vote&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">With more than 80&#37; agreement of the voting expert panel&#44; a <span class="elsevierStyleItalic">T</span>-score<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#8722;1&#46;7 was considered the most appropriate for treatment in postmenopausal women and men over 50 years of age under GC therapy&#46; This study could help in treatment decision-making in patients under GC therapy without fractures but other fracture risk factors should certainly be considered&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction and aim"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los umbrales del <span class="elsevierStyleItalic">T-score</span> de densidad mineral &#243;sea &#40;DMO&#41; podr&#237;an influir en el tratamiento de pacientes bajo terapia con glucocorticoides &#40;GC&#41;&#46; Se han descrito diferentes umbrales&#44; pero no existe un consenso internacional&#46; El objetivo de este trabajo fue encontrar un umbral que ayude en la decisi&#243;n terap&#233;utica en la poblaci&#243;n bajo tratamiento con GC&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se convoc&#243; un grupo de trabajo en representaci&#243;n de tres sociedades cient&#237;ficas de Argentina&#46; El primer equipo estuvo formado por especialistas con experiencia en osteoporosis inducida por glucocorticoides &#40;OIG&#41;&#44; quienes estuvieron a cargo de la votaci&#243;n basada en la evidencia&#46; El segundo equipo estuvo a cargo de la metodolog&#237;a coordinando y supervisando cada etapa&#46; Realizamos dos revisiones sistem&#225;ticas&#58; la primera incluy&#243; ensayos de f&#225;rmacos utilizados en OIG para analizar el <span class="elsevierStyleItalic">T-score</span> considerado como criterio de inclusi&#243;n&#46; En la segunda&#44; analizamos la evidencia sobre umbrales densitom&#233;tricos para la discriminaci&#243;n de pacientes fracturados y no fracturados bajo tratamiento con GC&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En la primera revisi&#243;n se incluyeron 31 art&#237;culos donde se hall&#243; que m&#225;s de 90&#37; de los ensayos incluyeron pacientes independientemente del <span class="elsevierStyleItalic">T-score</span> o en el rango de osteopenia&#46; En la segunda revisi&#243;n se incluyeron cuatro art&#237;culos donde observamos que m&#225;s de 80&#37; de los valores de <span class="elsevierStyleItalic">T-score</span> se encontraban entre -1&#44;6 y -2&#44;0&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Con un acuerdo superior a 80&#37; del panel de expertos&#44; un <span class="elsevierStyleItalic">T-score</span> &#8804; -1&#44;7 se consider&#243; el m&#225;s adecuado para el tratamiento en mujeres posmenop&#225;usicas y hombres mayores de 50 a&#241;os bajo tratamiento con GC&#46; Este estudio podr&#237;a ayudar en la decisi&#243;n terap&#233;utica en pacientes bajo tratamiento con GC sin fracturas&#44; pero ciertamente deber&#237;an considerarse otros factores de riesgos de fracturas complementarios&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n y objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0140" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia><elsevierMultimedia ident="upi0015"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0095"
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 4167
            "Ancho" => 1694
            "Tamanyo" => 504563
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flowcharts of both systematic review&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; BMD&#58; bone mineral density&#59; GIO&#58; glucocorticoid-induced osteoporosis&#59; LS&#58; lumbar spine&#59; TH&#58; total hip&#59; YAM&#58; young adult mean&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Densitometric inclusion criteria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Regardless of their baseline BMD&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">14&#44;16&#8211;19&#44;21&#8211;25&#44;28&#8211;30&#44;34&#8211;36</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BMD <span class="elsevierStyleItalic">T</span>-score at the lumbar spine &#40;LS&#41; and total hip &#40;TH&#41;&#58; either &#8804;&#8722;2&#46;0&#44; or &#8804;&#8722;1&#46;0 in addition to at least one fragility fracture during treatment with GC&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">38&#8211;42</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GIO according to Japanese Society for Bone and Mineral Research criteria &#40;2004&#41;&#58; <span class="elsevierStyleItalic">T</span>-score &#8722;1&#46;7&#59; 80&#37; YAM&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">15&#44;26&#44;37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BMD <span class="elsevierStyleItalic">T</span>-score at the LS or TH&#58; &#8804;&#8722;2&#46;5&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">20&#44;27&#44;33&#44;43</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BMD <span class="elsevierStyleItalic">T</span>-score at the LS&#58; &#8805;&#8722;2&#46;0&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">31</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BMD <span class="elsevierStyleItalic">T</span>-score at the LS&#58; &#60;&#8722;1&#46;0 and &#8805;&#8722;2&#46;5&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">32</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BMD <span class="elsevierStyleItalic">T</span>-score at the LS or TH&#58; &#60;&#8722;1&#46;0&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">44</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">T</span>-score as densitometric inclusion criteria in trials about GIO&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; BMD&#58; bone mineral density&#59; GIO&#58; glucocorticoid-induced osteoporosis&#59; RA&#58; rheumatoid arthritis&#59; SLE&#58; systemic lupus erythematosus&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Description&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Population&#47;site&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">T</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">van Staa&#44; et al&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">45</span></a> analyzed the BMD threshold for vertebral fracture in postmenopausal women taking GC versus placebo from 2 randomized clinical trials &#40;prevention and treatment trials of risedronate&#41;&#46;Total&#58; 111 postmenopausal women &#40;risedronate group&#41;&#44; 56 &#40;placebo group&#41;&#46;Age&#58; 59&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0 &#40;risedronate group&#41;&#44; 57&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3 &#40;placebo group&#41;&#46;Underlying diseases&#58; rheumatic&#44; pulmonary and skin disorders&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Control patients</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lumbar spine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Femoral neck&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">GC treated patients</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lumbar spine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Femoral neck&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="12" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nawata H&#44; et al&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">46</span></a> studied the BMD <span class="elsevierStyleItalic">T</span>-score cut-off which discriminates among fractured and non-fractured patients&#46;Total&#58; 692 patients &#40;627 women and 65 men&#41;&#46;Underlying diseases&#58; rheumatoid arthritis &#40;RA&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>319&#41;&#44; systemic lupus erythematosus &#40;SLE&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>162&#41;&#44; progressive systemic sclerosis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&#41;&#44; mixed connective tissue disease &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;&#44; polymyositis&#47;dermatomyositis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&#44; polymyalgia rheumatica &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41;&#44; nephropaty &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&#44; and 110 with other diseases&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">In all population</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primary osteoporosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Osteopenia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GC treated patients&#58; All population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GC treated patients&#58; RA population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GC treated patients&#58; SLE population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GC treated patients&#58; Non-RA population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">According to GC doses</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;5<span class="elsevierStyleHsp" style=""></span>mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;7&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;10<span class="elsevierStyleHsp" style=""></span>mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RA population &#40;&#8805;7&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kumagai S&#44; et al&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">47</span></a> is q cross-sectional study in women who had received at least 0&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg of oral GC for more than 1 month&#46;Total&#58; 160 Japanese womenAge&#58; 16&#8211;85 yearsUnderlying disease&#58; autoimmune diseases&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Premenopausal women&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Postmenopausal women&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kaji et al&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">48</span></a> studied the relationship between the presence or absence of vertebral fractures and BMD in 136 females Japanese patients treated with GC&#46; They analyzed the cut-off values on BMD for the incidence of vertebral fractures in those patients compared with controls&#46;Underlying disease&#58; autoimmune disease &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>102&#41;&#44; neurological disease &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41;&#44; dermatological disease &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;&#44; respiratory disease &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&#44; inflammatory bowel disease &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&#44; haematological disease &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Control patients</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">L2&#8211;L4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Femoral neck&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radius &#40;1&#47;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;2&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">GC treated patients</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">L2&#8211;L4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Femoral neck&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radius &#40;1&#47;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Analysis of the BMD <span class="elsevierStyleItalic">T</span>-score threshold for fractured and non-fractured discrimination in patients under GC therapy&#46;</p>"
        ]
      ]
      3 => array:5 [
        "identificador" => "upi0005"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:2 [
          "fichero" => "mmc1.pdf"
          "ficheroTamanyo" => 203609
        ]
      ]
      4 => array:5 [
        "identificador" => "upi0010"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:2 [
          "fichero" => "mmc2.pdf"
          "ficheroTamanyo" => 180337
        ]
      ]
      5 => array:5 [
        "identificador" => "upi0015"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:2 [
          "fichero" => "mmc3.pdf"
          "ficheroTamanyo" => 215528
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:51 [
            0 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictive value of BMD for hip and other fractures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "O&#46; Johnell"
                            1 => "J&#46;A&#46; Kanis"
                            2 => "A&#46; Oden"
                            3 => "H&#46; Johansson"
                            4 => "C&#46; De Laet"
                            5 => "P&#46; Delmas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1359/JBMR.050304"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Miner Res"
                        "fecha" => "2005"
                        "volumen" => "20"
                        "paginaInicial" => "1185"
                        "paginaFinal" => "1194"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15940371"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Executive summary of the 2019 ISCD position development conference on monitoring treatment&#44; DXA cross-calibration and least significant change&#44; spinal cord injury&#44; peri-prosthetic and orthopedic bone health&#44; transgender medicine&#44; and pediatrics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;R&#46; Shuhart"
                            1 => "S&#46;S&#46; Yeap"
                            2 => "P&#46;A&#46; Anderson"
                            3 => "L&#46;G&#46; Jankowski"
                            4 => "E&#46;M&#46; Lewiecki"
                            5 => "L&#46;R&#46; Morse"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jocd.2019.07.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Densitom"
                        "fecha" => "2019"
                        "volumen" => "22"
                        "paginaInicial" => "453"
                        "paginaFinal" => "471"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31400968"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis&#58; 2001 update&#46; American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/1529-0131(200107)44:7<1496::AID-ART271>3.0.CO;2-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "2001"
                        "volumen" => "44"
                        "paginaInicial" => "1496"
                        "paginaFinal" => "1503"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11465699"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Working group in collaboration with The Royal College of Physicians&#44; The Bone and Tooth Society of Great Britain&#44; and The National Osteoporosis Society&#46; Glucocorticoid-induced osteoporosis&#46; 2002&#46;"
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Grossman"
                            1 => "R&#46; Gordon"
                            2 => "V&#46;K&#46; Ranganath"
                            3 => "C&#46; Deal"
                            4 => "L&#46; Caplan"
                            5 => "W&#46; Chen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/acr.20295"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Care Res &#40;Hoboken&#41;"
                        "fecha" => "2010"
                        "volumen" => "62"
                        "paginaInicial" => "1515"
                        "paginaFinal" => "1526"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20662044"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Uncertainties in the prevention and treatment of glucocorticoid-induced osteoporosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46;E&#46; Hansen"
                            1 => "H&#46;A&#46; Wilson"
                            2 => "C&#46; Zapalowski"
                            3 => "H&#46;A&#46; Fink"
                            4 => "S&#46; Minisola"
                            5 => "R&#46;A&#46; Adler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/jbmr.362"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Miner Res"
                        "fecha" => "2011"
                        "volumen" => "26"
                        "paginaInicial" => "1989"
                        "paginaFinal" => "1996"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21721042"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "A framework for the development of guidelines for the management of glucocorticoid-induced osteoporosis"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Lekamwasam"
                            1 => "J&#46;D&#46; Adachi"
                            2 => "D&#46; Agnusdei"
                            3 => "J&#46; Bilezikian"
                            4 => "S&#46; Boonen"
                            5 => "F&#46; Borgstr&#246;m"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00198-012-1958-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Osteoporos Int"
                        "fecha" => "2012"
                        "volumen" => "23"
                        "paginaInicial" => "2257"
                        "paginaFinal" => "2276"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22434203"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2017 American College of Rheumatology Guideline for the prevention and treatment of glucocorticoid-induced osteoporosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Buckley"
                            1 => "G&#46; Guyatt"
                            2 => "H&#46;A&#46; Fink"
                            3 => "M&#46; Cannon"
                            4 => "J&#46; Grossman"
                            5 => "K&#46;E&#46; Hansen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/acr.23279"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Care Res &#40;Hoboken&#41;"
                        "fecha" => "2017"
                        "volumen" => "69"
                        "paginaInicial" => "1095"
                        "paginaFinal" => "1110"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28585410"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis&#58; an update of Brazilian Society of Rheumatology &#40;2020&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;M&#46;R&#46; Pereira"
                            1 => "M&#46;O&#46; Perez"
                            2 => "A&#46;P&#46; Paula"
                            3 => "C&#46; Moreira"
                            4 => "C&#46;H&#46;M&#46; Castro"
                            5 => "C&#46;A&#46;F&#46; Zerbini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11657-021-00902-z"
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Osteoporos"
                        "fecha" => "2021"
                        "volumen" => "16"
                        "paginaInicial" => "49"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33646403"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A longitudinal study of diagnosis and treatment for glucocorticoid-induced osteoporosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "I&#46; Tanaka"
                            1 => "H&#46; Oshima"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Osteoporosis Jpn"
                        "fecha" => "2003"
                        "volumen" => "11"
                        "paginaInicial" => "11"
                        "paginaFinal" => "14"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Critical evaluation of the Newcastle&#8211;Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Stang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10654-010-9491-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Epidemiol"
                        "fecha" => "2010"
                        "volumen" => "25"
                        "paginaInicial" => "603"
                        "paginaFinal" => "605"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20652370"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preferred reporting items for systematic review and meta-analysis protocols &#40;PRISMA-P&#41; 2015 statement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Moher"
                            1 => "L&#46; Shamseer"
                            2 => "M&#46; Clarke"
                            3 => "D&#46; Ghersi"
                            4 => "A&#46; Liberati"
                            5 => "M&#46; Petticrew"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/2046-4053-4-1"
                      "Revista" => array:5 [
                        "tituloSerie" => "Syst Rev"
                        "fecha" => "2015"
                        "volumen" => "4"
                        "paginaInicial" => "1"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25554246"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The PRISMA 2020 statement&#58; an updated guideline for reporting systematic reviews"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;J&#46; Page"
                            1 => "J&#46;E&#46; McKenzie"
                            2 => "P&#46;M&#46; Bossuyt"
                            3 => "I&#46; Boutron"
                            4 => "T&#46;C&#46; Hoffmann"
                            5 => "C&#46;D&#46; Mulrow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.n71"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2021"
                        "volumen" => "372"
                        "paginaInicial" => "n71"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33782057"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention of corticosteroid osteoporosis&#46; A comparison of calcium&#44; calcitriol&#44; and calcitonin"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Sambrook"
                            1 => "J&#46; Birmingham"
                            2 => "P&#46; Kelly"
                            3 => "S&#46; Kempler"
                            4 => "T&#46; Nguyen"
                            5 => "N&#46; Pocock"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199306173282404"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1993"
                        "volumen" => "328"
                        "paginaInicial" => "1747"
                        "paginaFinal" => "1752"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7684512"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eldecalcitol is superior to alfacalcidol in maintaining bone mineral density in glucocorticoid-induced osteoporosis patients &#40;e-GLORIA&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Matsumoto"
                            1 => "K&#46; Yamamoto"
                            2 => "T&#46; Takeuchi"
                            3 => "Y&#46; Tanaka"
                            4 => "S&#46; Tanaka"
                            5 => "T&#46; Nakano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00774-020-01091-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Miner Metab"
                        "fecha" => "2020"
                        "volumen" => "38"
                        "paginaInicial" => "522"
                        "paginaFinal" => "532"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32140784"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis&#46; Glucocorticoid-Induced Osteoporosis Intervention Study Group"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;G&#46; Saag"
                            1 => "R&#46; Emkey"
                            2 => "T&#46;J&#46; Schnitzer"
                            3 => "J&#46;P&#46; Brown"
                            4 => "F&#46; Hawkins"
                            5 => "S&#46; Goemaere"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199807303390502"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1998"
                        "volumen" => "339"
                        "paginaInicial" => "292"
                        "paginaFinal" => "299"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9682041"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Two-year effects of alendronate on bone mineral density and vertebral fracture in patients receiving glucocorticoids&#58; a randomized&#44; double-blind&#44; placebo-controlled extension trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;D&#46; Adachi"
                            1 => "K&#46;G&#46; Saag"
                            2 => "P&#46;D&#46; Delmas"
                            3 => "U&#46;A&#46; Liberman"
                            4 => "R&#46;D&#46; Emkey"
                            5 => "E&#46; Seeman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/1529-0131(200101)44:1<202::AID-ANR27>3.0.CO;2-W"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "2001"
                        "volumen" => "44"
                        "paginaInicial" => "202"
                        "paginaFinal" => "211"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11212161"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Positive effect of alendronate on bone mineral density and markers of bone turnover in patients with rheumatoid arthritis on chronic treatment with low-dose prednisone&#58; a randomized&#44; double-blind&#44; placebo-controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "W&#46;F&#46; Lems"
                            1 => "M&#46;C&#46; Lodder"
                            2 => "P&#46; Lips"
                            3 => "J&#46;W&#46; Bijlsma"
                            4 => "P&#46; Geusens"
                            5 => "N&#46; Schrameijer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00198-005-0037-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Osteoporos Int"
                        "fecha" => "2006"
                        "volumen" => "17"
                        "paginaInicial" => "716"
                        "paginaFinal" => "726"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16463007"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The bone mineral density effects of calcitonin in and alendronate combined therapy in patients with rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "K&#46; Ozoran"
                            1 => "M&#46; Yildirim"
                            2 => "M&#46; Onder"
                            3 => "F&#46; Sivas"
                            4 => "A&#46; Inanir"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "APLAR J Rheumatol"
                        "fecha" => "2007"
                        "volumen" => "10"
                        "paginaInicial" => "17"
                        "paginaFinal" => "22"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Once-weekly oral alendronate 70<span class="elsevierStyleHsp" style=""></span>mg in patients with glucocorticoid-induced bone loss&#58; a 12-month randomized&#44; placebo-controlled clinical trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;A&#46; Stoch"
                            1 => "K&#46;G&#46; Saag"
                            2 => "M&#46; Greenwald"
                            3 => "A&#46;I&#46; Sebba"
                            4 => "S&#46; Cohen"
                            5 => "N&#46; Verbruggen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3899/jrheum.081207"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "2009"
                        "volumen" => "36"
                        "paginaInicial" => "1705"
                        "paginaFinal" => "1714"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19487264"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention of glucocorticoid-induced osteoporosis in immunobullous diseases with alendronate&#58; a randomized&#44; double-blind&#44; placebo-controlled study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;I&#46; Tee"
                            1 => "G&#46; Yosipovitch"
                            2 => "Y&#46;C&#46; Chan"
                            3 => "S&#46;H&#46; Chua"
                            4 => "E&#46;T&#46; Koh"
                            5 => "Y&#46;H&#46; Chan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archdermatol.2011.354"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "2012"
                        "volumen" => "148"
                        "paginaInicial" => "307"
                        "paginaFinal" => "314"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22105813"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Alendronate or alfacalcidol in glucocorticoid-induced osteoporosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;N&#46; de Nijs"
                            1 => "J&#46;W&#46; Jacobs"
                            2 => "W&#46;F&#46; Lems"
                            3 => "R&#46;F&#46; Laan"
                            4 => "A&#46; Algra"
                            5 => "A&#46;M&#46; Huisman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa053569"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2006"
                        "volumen" => "355"
                        "paginaInicial" => "675"
                        "paginaFinal" => "684"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16914703"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical trial&#58; comparison of alendronate and alfacalcidol in glucocorticoid-associated osteoporosis in patients with ulcerative colitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Kitazaki"
                            1 => "K&#46; Mitsuyama"
                            2 => "J&#46; Masuda"
                            3 => "K&#46; Harada"
                            4 => "H&#46; Yamasaki"
                            5 => "K&#46; Kuwaki"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2036.2008.03899.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Aliment Pharmacol Ther"
                        "fecha" => "2009"
                        "volumen" => "29"
                        "paginaInicial" => "424"
                        "paginaFinal" => "430"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19035979"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of alendronate on glucocorticoid-induced osteoporosis in Japanese women with systemic autoimmune diseases&#58; versus alfacalcidol"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Takeda"
                            1 => "H&#46; Kaneoka"
                            2 => "T&#46; Saito"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10165-008-0055-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Mod Rheumatol"
                        "fecha" => "2008"
                        "volumen" => "18"
                        "paginaInicial" => "271"
                        "paginaFinal" => "276"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18427724"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention of bone loss with risedronate in glucocorticoid-treated rheumatoid arthritis patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Eastell"
                            1 => "J&#46;P&#46; Devogelaer"
                            2 => "N&#46;F&#46; Peel"
                            3 => "A&#46;A&#46; Chines"
                            4 => "D&#46;E&#46; Bax"
                            5 => "N&#46; Sacco-Gibson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s001980070122"
                      "Revista" => array:6 [
                        "tituloSerie" => "Osteoporos Int"
                        "fecha" => "2000"
                        "volumen" => "11"
                        "paginaInicial" => "331"
                        "paginaFinal" => "337"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10928223"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0385"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy and safety of sodium RISedronate for glucocorticoid-induced OstTeoporosis with rheumaTOid arthritis &#40;RISOTTO study&#41;&#58; a multicentre&#44; double-blind&#44; randomized&#44; placebo-controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46; Fujieda"
                            1 => "T&#46; Horita"
                            2 => "N&#46; Nishimoto"
                            3 => "K&#46; Tanimura"
                            4 => "Y&#46; Amasaki"
                            5 => "H&#46; Kasahara"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Mod Rheumatol"
                        "fecha" => "2020"
                        "volumen" => "2"
                        "paginaInicial" => "1"
                        "paginaFinal" => "7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0390"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparative studies on effect of risedronate and alfacalcidol against glucocorticoid-induced osteoporosis in rheumatoid arthritic patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Yamada"
                            1 => "H&#46; Takagi"
                            2 => "H&#46; Tsuchiya"
                            3 => "T&#46; Nakajima"
                            4 => "H&#46; Ochiai"
                            5 => "A&#46; Ichimura"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1248/yakushi.127.1491"
                      "Revista" => array:6 [
                        "tituloSerie" => "Yakugaku Zasshi"
                        "fecha" => "2007"
                        "volumen" => "127"
                        "paginaInicial" => "1491"
                        "paginaFinal" => "1496"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17827929"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0395"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risedronate therapy prevents corticosteroid-induced bone loss&#58; a twelve-month&#44; multicenter&#44; randomized&#44; double-blind&#44; placebo-controlled&#44; parallel-group study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Cohen"
                            1 => "R&#46;M&#46; Levy"
                            2 => "M&#46; Keller"
                            3 => "E&#46; Boling"
                            4 => "R&#46;D&#46; Emkey"
                            5 => "M&#46; Greenwald"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/1529-0131(199911)42:11<2309::AID-ANR8>3.0.CO;2-K"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "1999"
                        "volumen" => "42"
                        "paginaInicial" => "2309"
                        "paginaFinal" => "2318"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10555025"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0400"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy and safety of daily risedronate in the treatment of corticosteroid-induced osteoporosis in men and women&#58; a randomized trial&#46; European Corticosteroid-Induced Osteoporosis Treatment Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;M&#46; Reid"
                            1 => "R&#46;A&#46; Hughes"
                            2 => "R&#46;F&#46; Laan"
                            3 => "N&#46;A&#46; Sacco-Gibson"
                            4 => "D&#46;H&#46; Wenderoth"
                            5 => "S&#46; Adami"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1359/jbmr.2000.15.6.1006"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Miner Res"
                        "fecha" => "2000"
                        "volumen" => "15"
                        "paginaInicial" => "1006"
                        "paginaFinal" => "1013"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10841169"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0405"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of risedronate treatment on bone density and vertebral fracture in patients on corticosteroid therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Wallach"
                            1 => "S&#46; Cohen"
                            2 => "D&#46;M&#46; Reid"
                            3 => "R&#46;A&#46; Hughes"
                            4 => "D&#46;J&#46; Hosking"
                            5 => "R&#46;F&#46; Laan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Calcif Tissue Int"
                        "fecha" => "2000"
                        "volumen" => "67"
                        "paginaInicial" => "277"
                        "paginaFinal" => "285"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0410"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Once-monthly oral ibandronate provides significant improvement in bone mineral density in postmenopausal women treated with glucocorticoids for inflammatory rheumatic diseases&#58; a 12-month&#44; randomized&#44; double-blind&#44; placebo-controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Hakala"
                            1 => "H&#46; Kr&#246;ger"
                            2 => "H&#46; Valleala"
                            3 => "T&#46; Hienonen-Kempas"
                            4 => "M&#46; Lehtonen-Veromaa"
                            5 => "J&#46; Heikkinen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/03009742.2012.664647"
                      "Revista" => array:6 [
                        "tituloSerie" => "Scand J Rheumatol"
                        "fecha" => "2012"
                        "volumen" => "41"
                        "paginaInicial" => "260"
                        "paginaFinal" => "266"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22803768"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0415"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Monthly oral ibandronate reduces bone loss in Korean women with rheumatoid arthritis and osteopenia receiving long-term glucocorticoids&#58; a 48-week double-blinded randomized placebo-controlled investigator-initiated trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Shin"
                            1 => "S&#46;H&#46; Park"
                            2 => "W&#46; Park"
                            3 => "H&#46;J&#46; Baek"
                            4 => "Y&#46;J&#46; Lee"
                            5 => "S&#46;W&#46; Kang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clinthera.2017.01.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Ther"
                        "fecha" => "2017"
                        "volumen" => "39"
                        "paginaInicial" => "268"
                        "paginaFinal" => "278"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28161119"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0420"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intermittent intravenous ibandronate injections reduce vertebral fracture risk in corticosteroid-induced osteoporosis&#58; results from a long-term comparative study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;D&#46; Ringe"
                            1 => "A&#46; Dorst"
                            2 => "H&#46; Faber"
                            3 => "K&#46; Ibach"
                            4 => "F&#46; Sorenson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00198-003-1425-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Osteoporos Int"
                        "fecha" => "2003"
                        "volumen" => "14"
                        "paginaInicial" => "801"
                        "paginaFinal" => "807"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14610641"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0425"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Primary prevention of glucocorticoid-induced osteoporosis with intermittent intravenous pamidronate&#58; a randomized trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Y&#46; Boutsen"
                            1 => "J&#46; Jamart"
                            2 => "W&#46; Esselinckx"
                            3 => "M&#46; Stoffel"
                            4 => "J&#46;P&#46; Devogelaer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s002239900334"
                      "Revista" => array:6 [
                        "tituloSerie" => "Calcif Tissue Int"
                        "fecha" => "1997"
                        "volumen" => "61"
                        "paginaInicial" => "266"
                        "paginaFinal" => "271"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9312195"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0430"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Primary prevention of glucocorticoid-induced osteoporosis with intravenous pamidronate and calcium&#58; a prospective controlled 1-year study comparing a single infusion&#44; an infusion given once every 3 months&#44; and calcium alone"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Y&#46; Boutsen"
                            1 => "J&#46; Jamart"
                            2 => "W&#46; Esselinckx"
                            3 => "J&#46;P&#46; Devogelaer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1359/jbmr.2001.16.1.104"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Miner Res"
                        "fecha" => "2001"
                        "volumen" => "16"
                        "paginaInicial" => "104"
                        "paginaFinal" => "112"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11149473"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0435"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Zoledronic acid and risedronate in the prevention and treatment of glucocorticoid-induced osteoporosis &#40;HORIZON&#41;&#58; a multicentre&#44; double-blind&#44; double-dummy&#44; randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;M&#46; Reid"
                            1 => "J&#46;P&#46; Devogelaer"
                            2 => "K&#46; Saag"
                            3 => "C&#46; Roux"
                            4 => "C&#46;S&#46; Lau"
                            5 => "J&#46;Y&#46; Reginster"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(09)60250-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2009"
                        "volumen" => "373"
                        "paginaInicial" => "1253"
                        "paginaFinal" => "1263"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19362675"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0440"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effects of denosumab and alendronate on glucocorticoid-induced osteoporosis in patients with glomerular disease&#58; a randomized&#44; controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Iseri"
                            1 => "M&#46; Iyoda"
                            2 => "M&#46; Watanabe"
                            3 => "K&#46; Matsumoto"
                            4 => "D&#46; Sanada"
                            5 => "T&#46; Inoue"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0193846"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLOS ONE"
                        "fecha" => "2018"
                        "volumen" => "13"
                        "paginaInicial" => "e0193846"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29543887"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0445"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Denosumab versus risedronate in glucocorticoid-induced osteoporosis&#58; a multicentre&#44; randomised&#44; double-blind&#44; active-controlled&#44; double-dummy&#44; non-inferiority study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;G&#46; Saag"
                            1 => "R&#46;B&#46; Wagman"
                            2 => "P&#46; Geusens"
                            3 => "J&#46;D&#46; Adachi"
                            4 => "O&#46;D&#46; Messina"
                            5 => "R&#46; Emkey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S2213-8587(18)30075-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Diabetes Endocrinol"
                        "fecha" => "2018"
                        "volumen" => "6"
                        "paginaInicial" => "445"
                        "paginaFinal" => "454"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29631782"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0450"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Denosumab versus risedronate in glucocorticoid-induced osteoporosis&#58; final results of a twenty-four-month randomized&#44; double-blind&#44; double-dummy trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;G&#46; Saag"
                            1 => "N&#46; Pannacciulli"
                            2 => "P&#46; Geusens"
                            3 => "J&#46;D&#46; Adachi"
                            4 => "O&#46;D&#46; Messina"
                            5 => "J&#46; Morales-Torres"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.40874"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheumatol"
                        "fecha" => "2019"
                        "volumen" => "71"
                        "paginaInicial" => "1174"
                        "paginaFinal" => "1184"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30816640"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0455"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Teriparatide or alendronate in glucocorticoid-induced osteoporosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;G&#46; Saag"
                            1 => "E&#46; Shane"
                            2 => "S&#46; Boonen"
                            3 => "F&#46; Mar&#237;n"
                            4 => "D&#46;W&#46; Donley"
                            5 => "K&#46;A&#46; Taylor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa071408"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2007"
                        "volumen" => "357"
                        "paginaInicial" => "2028"
                        "paginaFinal" => "2039"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18003959"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0460"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Teriparatide versus alendronate for treating glucocorticoid-induced osteoporosis&#58; an analysis by gender and menopausal status"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46;L&#46; Langdahl"
                            1 => "F&#46; Marin"
                            2 => "E&#46; Shane"
                            3 => "H&#46; Dobnig"
                            4 => "J&#46;R&#46; Zanchetta"
                            5 => "M&#46; Maricic"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00198-009-0917-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Osteoporos Int"
                        "fecha" => "2009"
                        "volumen" => "20"
                        "paginaInicial" => "2095"
                        "paginaFinal" => "2104"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19350340"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0465"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of teriparatide versus alendronate for treating glucocorticoid-induced osteoporosis&#58; thirty-six-month results of a randomized&#44; double-blind&#44; controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;G&#46; Saag"
                            1 => "J&#46;R&#46; Zanchetta"
                            2 => "J&#46;P&#46; Devogelaer"
                            3 => "R&#46;A&#46; Adler"
                            4 => "R&#46; Eastell"
                            5 => "K&#46; See"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.24879"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "2009"
                        "volumen" => "60"
                        "paginaInicial" => "3346"
                        "paginaFinal" => "3355"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19877063"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0470"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bone mass continues to increase at the hip after parathyroid hormone treatment is discontinued in glucocorticoid-induced osteoporosis&#58; results of a randomized controlled clinical trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46;E&#46; Lane"
                            1 => "S&#46; Sanchez"
                            2 => "G&#46;W&#46; Modin"
                            3 => "H&#46;K&#46; Genant"
                            4 => "E&#46; Pierini"
                            5 => "C&#46;D&#46; Arnaud"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1359/jbmr.2000.15.5.944"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Bone Miner Res"
                        "fecha" => "2000"
                        "volumen" => "15"
                        "paginaInicial" => "944"
                        "paginaFinal" => "951"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0475"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Raloxifene for postmenopausal women with systemic lupus erythematosus&#58; a pilot randomized controlled study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;C&#46; Mok"
                            1 => "C&#46;H&#46; To"
                            2 => "A&#46; Mak"
                            3 => "K&#46;M&#46; Ma"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "2005"
                        "volumen" => "52"
                        "paginaInicial" => "3997"
                        "paginaFinal" => "4002"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0480"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bone density threshold and other predictors of vertebral fracture in patients receiving oral glucocorticoid therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "T&#46;P&#46; Van Staa"
                            1 => "R&#46;F&#46; Laan"
                            2 => "I&#46;P&#46; Barton"
                            3 => "S&#46; Cohen"
                            4 => "D&#46;M&#46; Reid"
                            5 => "C&#46; Cooper"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.11283"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "2003"
                        "volumen" => "48"
                        "paginaInicial" => "3224"
                        "paginaFinal" => "3229"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14613287"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0485"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines on the management and treatment of glucocorticoid-induced osteoporosis of the Japanese Society for Bone and Mineral Research &#40;2004&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Nawata"
                            1 => "S&#46; Soen"
                            2 => "R&#46; Takayanagi"
                            3 => "I&#46; Tanaka"
                            4 => "K&#46; Takaoka"
                            5 => "M&#46; Fukunaga"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00774-004-0596-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Miner Metab"
                        "fecha" => "2005"
                        "volumen" => "23"
                        "paginaInicial" => "105"
                        "paginaFinal" => "109"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15750687"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0490"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vertebral fracture and bone mineral density in women receiving high dose glucocorticoids for treatment of autoimmune diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Kumagai"
                            1 => "S&#46; Kawano"
                            2 => "T&#46; Atsumi"
                            3 => "S&#46; Inokuma"
                            4 => "Y&#46; Okada"
                            5 => "Y&#46; Kanai"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "2005"
                        "volumen" => "32"
                        "paginaInicial" => "863"
                        "paginaFinal" => "869"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15868623"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0495"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The threshold of bone mineral density for vertebral fracture in female patients with glucocorticoid-induced osteoporosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46; Kaji"
                            1 => "M&#46; Yamauchi"
                            2 => "K&#46; Chihara"
                            3 => "T&#46; Sugimoto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1507/endocrj.53.27"
                      "Revista" => array:6 [
                        "tituloSerie" => "Endocr J"
                        "fecha" => "2006"
                        "volumen" => "53"
                        "paginaInicial" => "27"
                        "paginaFinal" => "34"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16543669"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0500"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A systematic review of hip fracture incidence and probability of fracture worldwide"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; Kanis"
                            1 => "A&#46; Od&#233;n"
                            2 => "E&#46;V&#46; McCloskey"
                            3 => "H&#46; Johansson"
                            4 => "D&#46;A&#46; Wahl"
                            5 => "C&#46; Cooper"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00198-012-1964-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Osteoporos Int"
                        "fecha" => "2012"
                        "volumen" => "23"
                        "paginaInicial" => "2239"
                        "paginaFinal" => "2256"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22419370"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0505"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Case finding for the management of osteoporosis with FRAX &#8211; assessment and intervention thresholds for the UK"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; Kanis"
                            1 => "E&#46;V&#46; McCloskey"
                            2 => "H&#46; Johansson"
                            3 => "O&#46; Strom"
                            4 => "F&#46; Borgstrom"
                            5 => "A&#46; Oden"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00198-008-0712-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Osteoporos Int"
                        "fecha" => "2008"
                        "volumen" => "19"
                        "paginaInicial" => "1395"
                        "paginaFinal" => "1408"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18751937"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib0510"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Dawson-Hughes"
                            1 => "A&#46;N&#46; Tosteson"
                            2 => "L&#46;J&#46; Melton 3rd&#46;"
                            3 => "S&#46; Baim"
                            4 => "M&#46;J&#46; Favus"
                            5 => "S&#46; Khosla"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00198-008-0559-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Osteoporos Int"
                        "fecha" => "2008"
                        "volumen" => "19"
                        "paginaInicial" => "449"
                        "paginaFinal" => "458"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18292975"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/1699258X/0000001900000005/v1_202304271842/S1699258X22002297/v1_202304271842/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "93548"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Originales"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/1699258X/0000001900000005/v1_202304271842/S1699258X22002297/v1_202304271842/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X22002297?idApp=UINPBA00004M"
]
Compartir
Información de la revista
Vol. 19. Núm. 5.
Páginas 279-284 (mayo 2023)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 19. Núm. 5.
Páginas 279-284 (mayo 2023)
Original article
Threshold based on bone mineral density for therapeutic decision-making in postmenopausal women and men over 50 years old under glucocorticoid therapy
Umbral densitométrico de densidad mineral ósea para considerar tratamiento en pacientes mujeres posmenopáusicas y hombres mayores de 50 años en tratamiento con glucocorticoids
María Lorena Brancea,b,c,
Autor para correspondencia
lorenabrance@gmail.com

Corresponding author.
, María Silvia Larroudéd, Luis Fernando Sommae, Evangelina Giacoiaf, María Diehlg, Ana María Galichg, Luis Agustín Ramirez Stiebenh, María Cielo Maheri, María De La Vegaj, Ariana Ringera,k, Lucas R. Brunb,c
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 Nacional Prof. A. Posadas, Buenos Aires, Argentina
g Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
h Hospital Privado de Rosario (Grupo Gamma), Rosario, Argentina
i Instituto de Rehabilitación Psicofísica (IREP), Buenos Aires, Argentina
j Ceim Investigaciones Médicas, Buenos Aires, Argentina
k Hospital Provincial del Centenario, Rosario, Argentina
Ver más

Estadísticas

Siga este enlace para acceder al texto completo del artículo

Original article
Threshold based on bone mineral density for therapeutic decision-making in postmenopausal women and men over 50 years old under glucocorticoid therapy
Umbral densitométrico de densidad mineral ósea para considerar tratamiento en pacientes mujeres posmenopáusicas y hombres mayores de 50 años en tratamiento con glucocorticoids
María Lorena Brancea,b,c,
Autor para correspondencia
lorenabrance@gmail.com

Corresponding author.
, María Silvia Larroudéd, Luis Fernando Sommae, Evangelina Giacoiaf, María Diehlg, Ana María Galichg, Luis Agustín Ramirez Stiebenh, María Cielo Maheri, María De La Vegaj, Ariana Ringera,k, Lucas R. Brunb,c
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 Nacional Prof. A. Posadas, Buenos Aires, Argentina
g Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
h Hospital Privado de Rosario (Grupo Gamma), Rosario, Argentina
i Instituto de Rehabilitación Psicofísica (IREP), Buenos Aires, Argentina
j Ceim Investigaciones Médicas, Buenos Aires, Argentina
k Hospital Provincial del Centenario, Rosario, Argentina
Ver más
Leído
1323
Veces
se ha leído el artículo
540
Total PDF
783
Total HTML
Compartir estadísticas
 array:23 [
  "pii" => "S1699258X22002297"
  "issn" => "1699258X"
  "doi" => "10.1016/j.reuma.2022.10.002"
  "estado" => "S300"
  "fechaPublicacion" => "2023-05-01"
  "aid" => "1652"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
  "copyrightAnyo" => "2022"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Reumatol Clin. 2023;19:279-84"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S1699258X2200184X"
    "issn" => "1699258X"
    "doi" => "10.1016/j.reuma.2022.08.006"
    "estado" => "S300"
    "fechaPublicacion" => "2023-05-01"
    "aid" => "1645"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Reumatol Clin. 2023;19:285-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
      "titulo" => "Trichorhinophalangeal syndrome type 1 &#40;Giedion syndrome&#41;&#58; A case report with literature review"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "285"
          "paginaFinal" => "289"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "S&#237;ndrome tricorrinofal&#225;ngico tipo 1 &#40;s&#237;ndrome de Giedion&#41;&#58; caso cl&#237;nico y revisi&#243;n de la literatura"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Fig&#46; 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 936
              "Ancho" => 1674
              "Tamanyo" => 178523
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Intraoral view of the patient &#40;1 week after surgery&#41;&#46; &#40;A&#41; Anterior open-bite with dental crowding&#59; &#40;B&#41; high-arched palate&#59; &#40;C and D&#41; bilateral posterior cross-bite with dental crowding&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Canseda Ava&#287;, Selen Adilo&#287;lu, Murat Akkocao&#287;lu"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Canseda"
              "apellidos" => "Ava&#287;"
            ]
            1 => array:2 [
              "nombre" => "Selen"
              "apellidos" => "Adilo&#287;lu"
            ]
            2 => array:2 [
              "nombre" => "Murat"
              "apellidos" => "Akkocao&#287;lu"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X2200184X?idApp=UINPBA00004M"
    "url" => "/1699258X/0000001900000005/v1_202304271842/S1699258X2200184X/v1_202304271842/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1699258X22001838"
    "issn" => "1699258X"
    "doi" => "10.1016/j.reuma.2022.08.005"
    "estado" => "S300"
    "fechaPublicacion" => "2023-05-01"
    "aid" => "1644"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Reumatol Clin. 2023;19:273-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "es" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
      "titulo" => "Necesidades&#44; impacto y perspectiva actual de los pacientes con espondiloartritis incluyendo la artritis psori&#225;sica"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "273"
          "paginaFinal" => "278"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Patients with spondyloarthritis including psoriatic arthritis&#58; Current needs&#44; impact&#44; and perspective"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Est&#237;baliz Loza, Pedro Plazuelo,  Ceade"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Est&#237;baliz"
              "apellidos" => "Loza"
            ]
            1 => array:2 [
              "nombre" => "Pedro"
              "apellidos" => "Plazuelo"
            ]
            2 => array:1 [
              "apellidos" => "Ceade"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S217357432300062X"
        "doi" => "10.1016/j.reumae.2022.08.006"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357432300062X?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X22001838?idApp=UINPBA00004M"
    "url" => "/1699258X/0000001900000005/v1_202304271842/S1699258X22001838/v1_202304271842/es/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Threshold based on bone mineral density for therapeutic decision-making in postmenopausal women and men over 50 years old under glucocorticoid therapy"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "279"
        "paginaFinal" => "284"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Mar&#237;a Lorena Brance, Mar&#237;a Silvia Larroud&#233;, Luis Fernando Somma, Evangelina Giacoia, Mar&#237;a Diehl, Ana Mar&#237;a Galich, Luis Agust&#237;n Ramirez Stieben, Mar&#237;a Cielo Maher, Mar&#237;a De La Vega, Ariana Ringer, Lucas R&#46; Brun"
        "autores" => array:11 [
          0 => array:4 [
            "nombre" => "Mar&#237;a Lorena"
            "apellidos" => "Brance"
            "email" => array:1 [
              0 => "lorenabrance@gmail.com"
            ]
            "referencia" => array:4 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Mar&#237;a Silvia"
            "apellidos" => "Larroud&#233;"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Luis Fernando"
            "apellidos" => "Somma"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Evangelina"
            "apellidos" => "Giacoia"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Mar&#237;a"
            "apellidos" => "Diehl"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "aff0035"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Ana Mar&#237;a"
            "apellidos" => "Galich"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "aff0035"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Luis Agust&#237;n"
            "apellidos" => "Ramirez Stieben"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">h</span>"
                "identificador" => "aff0040"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Mar&#237;a Cielo"
            "apellidos" => "Maher"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">i</span>"
                "identificador" => "aff0045"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Mar&#237;a"
            "apellidos" => "De La Vega"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">j</span>"
                "identificador" => "aff0050"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "Ariana"
            "apellidos" => "Ringer"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">k</span>"
                "identificador" => "aff0055"
              ]
            ]
          ]
          10 => array:3 [
            "nombre" => "Lucas R&#46;"
            "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:11 [
          0 => array:3 [
            "entidad" => "Reumatolog&#237;a y Enfermedades &#211;seas&#44; Rosario&#44; Argentina"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Bone Biology Laboratory&#44; School of Medicine&#44; Rosario National University&#44; Argentina"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "National Council of Scientific and Technical Research &#40;CONICET&#41;&#44; Argentina"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Centro Rossi&#44; Buenos Aires&#44; Argentina"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Consultorio de Reumatologia y Osteoporosis&#44; Lujan&#44; Argentina"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
          5 => array:3 [
            "entidad" => "Hospital Nacional Prof&#46; A&#46; Posadas&#44; Buenos Aires&#44; Argentina"
            "etiqueta" => "f"
            "identificador" => "aff0030"
          ]
          6 => array:3 [
            "entidad" => "Hospital Italiano de Buenos Aires&#44; Buenos Aires&#44; Argentina"
            "etiqueta" => "g"
            "identificador" => "aff0035"
          ]
          7 => array:3 [
            "entidad" => "Hospital Privado de Rosario &#40;Grupo Gamma&#41;&#44; Rosario&#44; Argentina"
            "etiqueta" => "h"
            "identificador" => "aff0040"
          ]
          8 => array:3 [
            "entidad" => "Instituto de Rehabilitaci&#243;n Psicof&#237;sica &#40;IREP&#41;&#44; Buenos Aires&#44; Argentina"
            "etiqueta" => "i"
            "identificador" => "aff0045"
          ]
          9 => array:3 [
            "entidad" => "Ceim Investigaciones M&#233;dicas&#44; Buenos Aires&#44; Argentina"
            "etiqueta" => "j"
            "identificador" => "aff0050"
          ]
          10 => array:3 [
            "entidad" => "Hospital Provincial del Centenario&#44; Rosario&#44; Argentina"
            "etiqueta" => "k"
            "identificador" => "aff0055"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Umbral densitom&#233;trico de densidad mineral &#243;sea para considerar tratamiento en pacientes mujeres posmenop&#225;usicas y hombres mayores de 50 a&#241;os en tratamiento con glucocorticoids"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 4167
            "Ancho" => 1694
            "Tamanyo" => 504563
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flowcharts of both systematic review&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Bone mineral density &#40;BMD&#41; measured by dual X-ray absorptiometry &#40;DXA&#41; is the current gold standard reference for the diagnosis of osteoporosis&#46; Since BMD is one of the strongest predictors of fracture risk&#44; many agencies worldwide have adopted BMD-based criteria as intervention thresholds&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">1</span></a> According to existing guidelines for postmenopausal women&#44; a <span class="elsevierStyleItalic">T</span>-score of &#8722;2&#46;5 SD or lower is recommended to offer treatment in those patients without fragility fractures&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">2</span></a> The <span class="elsevierStyleItalic">T</span>-score BMD thresholds might influence current guidance for treatment in patients under glucocorticoid &#40;GC&#41; therapy&#46; Different BMD thresholds were described throughout the time&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">3&#8211;9</span></a> Several differences exist between the 2001 and 2010 American College of Rheumatology &#40;ACR&#41; glucocorticoid-induced osteoporosis &#40;GIO&#41; guidelines&#46; In 2001&#44; the ACR guideline recommended treatment for GIO in any patient with a <span class="elsevierStyleItalic">T</span>-score below &#8722;1&#46;0&#46; On the other hand&#44; in 2010 the treatment was suggested considering the low&#44; moderate&#44; or high-risk of fracture&#46; The ASBMR-PPC &#40;American Society for Bone and Mineral Research-Professional Practice Committee&#41; also stratified postmenopausal women and men<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>50 years into low&#44; medium&#44; and high risk of fracture according to FRAX score&#46; For patients who had low risk but have an indication for prednisone &#62;7&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#44; the recommendation is to indicate treatment but for those with lower GC doses&#44; the suggestion is to monitor the patient with BMD&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">6</span></a> In 2012&#44; the IOF-ECTS GIO Guidelines Working Group defined a BMD <span class="elsevierStyleItalic">T</span>-score lower than &#8722;1&#46;5 as one of the indications for bone-protective therapy in postmenopausal women and men &#8805;50 years under GC therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">7</span></a> The Japanese guidelines also consider it as a cut-off value of BMD in around 80&#37; of the young adult population&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">10</span></a> The ACR guideline 2017 recommended initial pharmacologic treatment in adults<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>40 years of age who are at moderate-to-high risk of fracture considering high-risk to those with <span class="elsevierStyleItalic">T</span>-score<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#8722;2&#46;5&#44; by FRAX GC-adjusted or with a prior fragility fracture&#46; Recently&#44; the 2020 GIO Brazilian guidelines recommended a <span class="elsevierStyleItalic">T</span>-score<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#8722;1&#46;89 for treatment in men&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">8</span></a> Consequently&#44; there is no international consensus regarding the BMD cut-off for diagnosis and treatment in GIO&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Therefore&#44; in the context of the development of Argentine guidelines for prevention and treatment of GIO&#44; a working group on behalf of three scientific societies from Argentina&#58; AAOMM &#40;<span class="elsevierStyleItalic">Asociaci&#243;n Argentina de Osteolog&#237;a y Metabolismo Mineral</span> &#8211; Argentine Association of Osteology and Mineral Metabolism&#41;&#44; SAO &#40;<span class="elsevierStyleItalic">Sociedad Argentina de Osteoporosis</span> &#8211; Argentine Osteoporosis Society&#41; and SAR &#40;<span class="elsevierStyleItalic">Sociedad Argentina de Reumatolog&#237;a</span> &#8211; Argentine Society of Rheumatology&#41; was convened to identify areas of consensus among a panel of experts&#44; with the aim of discussing the available data for the threshold based on BMD for therapeutic decision-making in postmenopausal and men<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>50 years under GC therapy&#46; In the absence of a consensus about a cut-off for the diagnosis of GIO&#44; there is a risk of not identifying those patients who&#44; under GC therapy&#44; are at risk of fragility fracture&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Objective</span><p id="par0015" class="elsevierStylePara elsevierViewall">The overall aim of this study was to find a threshold according to the reported evidence to be able to help in the treatment decision in the population under GC therapy&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><span id="sec0020" class="el