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2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis: ACR GUIDELINE FOR GLUCOCORTICOID-INDUCED OSTEOPOROSIS PREVENTION AND TREATMENT

Published on Aug 1, 2017in Arthritis & Rheumatism9.002
· DOI :10.1002/art.40137
Lenore M. Buckley4
Estimated H-index: 4
(Yale University),
Gordon H. Guyatt201
Estimated H-index: 201
(McMaster University)
+ 18 AuthorsTimothy E. McAlindon57
Estimated H-index: 57
(Tufts Medical Center)
Abstract
  • References (53)
  • Citations (53)
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References53
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#1LeBlancClaire (McGill University)H-Index: 18
#2Jinhui Ma (U of O: University of Ottawa)H-Index: 16
Last. Leanne M. Ward (U of O: University of Ottawa)H-Index: 38
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Vertebral fractures are an important yet under-recognized manifestation of osteoporosis in children with chronic, glucocorticoid-treated illnesses. Our goal was to determine the incidence and clinical predictors of vertebral fractures in the three years following glucocorticoid initiation among pediatric patients with rheumatic disorders. Incident vertebral fractures were evaluated according to the Genant semi-quantitative method on lateral radiographs at baseline and then annually in the 3 year...
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#2Holger J. Schünemann (McMaster University)H-Index: 109
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#1Laurence FardetH-Index: 24
#2Irene PetersenH-Index: 38
Last. Irwin NazarethH-Index: 59
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AbstractAbout 1% of the general population receives long-term systemic glucocorticoids. The monitoring provided to these patients is unknown.We conducted a population-based cohort study using The Health Improvement Network database. A total of 100,944 adult patients prescribed systemic glucocorticoi
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#1Sarah B. Green (UNC: University of North Carolina at Chapel Hill)H-Index: 1
#2Ashley L. PappasH-Index: 2
Purpose A review of case reports and other published data on fetal and neonatal outcomes associated with maternal use of bisphosphonate medications is presented. Summary Bisphosphonates can persist in the bone matrix for years, even after therapy is discontinued, potentially resulting in fetal bisphosphonate exposure during pregnancy. Adverse effects of bisphosphonates on fetal outcomes have been observed in animal studies, but the bisphosphonate doses administered were much higher than those ty...
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#1Karen Elizabeth Hansen M. D. Ccd (UW: University of Wisconsin-Madison)H-Index: 21
#2Brian Kleker (KP: Kaiser Permanente)H-Index: 1
Last. Christie M. Bartels (UW: University of Wisconsin-Madison)H-Index: 19
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Objective: To summarize the published effects of systemic glucocorticoid therapy on bone mineral density (BMD) and fractures in children. Methods: We performed a systematic review and meta-analysis of existing literature, using Medline, CINAHL, and Cochrane databases to identify studies of BMD or fractures in children r18 years taking systemic glucocorticoid therapy. We excluded studies of inhaled glucocorticoids, chemotherapy, and organ transplantation. Two authors reviewed abstracts for inclus...
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#1Rogely Waite Boyce (Amgen)H-Index: 13
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Abstract RANKL is a key regulator of bone resorption and osteoclastogenesis. Denosumab is a fully human IgG2 monoclonal antibody that inhibits bone resorption by binding and inhibiting the activity of RANKL. To determine the effects of denosumab on pre- and postnatal skeletal growth and development, subcutaneous injections of 0 (control) or 50 mg/kg/month denosumab were given to pregnant cynomolgus monkeys from approximately gestation day (GD) 20 until parturition (up to 6 doses). For up to 6 mo...
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Abstract Denosumab is a monoclonal antibody that inhibits bone resorption by targeting RANKL, an essential mediator of osteoclast formation, function, and survival. Reproductive toxicity of denosumab was assessed in cynomolgus monkeys in an embryofetal development study (dosing GD20–50) and a pre-postnatal toxicity study (dosing GD20–parturition). In the embryofetal toxicity study, denosumab did not elicit maternal toxicity, fetal harm or teratogenicity. In the pre-postnatal toxicity study, ther...
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#1Jeffrey C Andrews (Vandy: Vanderbilt University)H-Index: 12
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Last. Gordon H. Guyatt (McMaster University)H-Index: 201
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Abstract In the GRADE approach, the strength of a recommendation reflects the extent to which we can be confident that the composite desirable effects of a management strategy outweigh the composite undesirable effects. This article addresses GRADE's approach to determining the direction and strength of a recommendation. The GRADE describes the balance of desirable and undesirable outcomes of interest among alternative management strategies depending on four domains, namely estimates of effect f...
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#1Jeffrey C Andrews (Vandy: Vanderbilt University)H-Index: 12
#2Gordon H. Guyatt (McMaster University)H-Index: 201
Last. Holger J. Schünemann (McMaster University)H-Index: 109
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Abstract This article describes the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to classifying the direction and strength of recommendations. The strength of a recommendation, separated into strong and weak, is defined as the extent to which one can be confident that the desirable effects of an intervention outweigh its undesirable effects. Alternative terms for a weak recommendation include conditional, discretionary, or qualified. The strength of a recom...
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#1Celia Rodd (McGill University)H-Index: 9
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Objective. To determine the frequency of incident vertebral fractures (IVF) 12 months after glucocorticoid (GC) initiation in children with rheumatic diseases and to identify children at higher risk. Methods. Children with rheumatic diseases initiating GC were enrolled in a prospective observational study. Annual spine radiographs were evaluated using the Genant semiquantitative method. Spine areal bone mineral density (aBMD) was measured every 6 months. Clinical features, including cumulative G...
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Autophagy is an evolutionarily conserved dynamic process and present in variety of cells at basal levels to maintain homeostasis and to promote cell survival in response to stresses. The early bone loss with excessive glucocorticoids (GCs) was reported to be related with the extension of the life span of osteoclasts. However, the connection between GCs induced bone loss and osteoclast autophagy remains to be elucidated. Autophagy was detected in a Dexamethasone (Dex) induced osteoporotic mice mo...
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#1Ling LiuH-Index: 2
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The objective of this study is to investigate the protective role of hesperetin for the glucocorticoid-induced osteoporosis (GIOP) and related mechanisms. In this study, we investigated the protective effects of hesperetin on dexamethasone (DEX)-induced osteogenic inhibition in bone marrow mesenchymal stem cells (BMSCs). The mineralization, real-time quantitative polymerase chain reaction assays (RT-qPCR), immunofluorescence and western blot were used to assess the protective effects of hesperet...
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Osteopenia and osteoporosis are common features in inflammatory bowel disease (IBD), comprising both Crohn’s disease and ulcerative colitis. Moreover, Crohn’s disease is associated with increased fracture risk. The etiology of bone loss in IBD is multifactorial. It includes insufficient intake or absorption of calcium, vitamin D, and potassium; smoking; a low peak bone mass; a low body mass index; and decreased physical activity. In several studies, it has been shown that elevated concentrations...
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BACKGROUND: Osteoporosis incidence in children is increasing due to the increased survival rate of patients suffering from chronic diseases and the increased use of drugs that can damage bones. Recent changes made to the definition of childhood osteoporosis, along with the lack of guidelines or national consensuses regarding its diagnosis and treatment, have resulted in a wide variability in the approaches used to treat this disease. For these reasons, the Osteogenesis Imperfecta and Childhood O...
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Exposure to oral corticosteroids (OCS) is associated with an increased risk of osteoporosis and fragility fractures. Guidelines suggest bisphosphonate (BP) therapy as the first-line treatment of glucocorticoid-induced osteoporosis (GIOP). This population study used publicly available data, including prescription annual cost analysis and monthly practice-level data. Our aim was to examine the prescribing of OCS and BP at practice level and investigate reasons for variation using a mixed-effect ne...
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