rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2018-144-151rsp-2518Research ArticleМЕЖДУНАРОДНЫЕ И РОССИЙСКИЕ РЕКОМЕНДАЦИИ ПО ЛЕЧЕНИЮ РЕВМАТИЧЕСКИХ ЗАБОЛЕВАНИЙINTERNATIONAL AND RUSSIAN GUIDELINES FOR THE TREATMENT OF RHEUMATIC DISEASESОбзор клинических рекомендаций Американской коллегии ревматологов (ACR) по профилактике и лечению глюкокортикоидного остеопорозаREVIEW OF AMERICAN COLLEGE OF RHEUMATOLOGY (ACR) CLINICAL GUIDELINES FOR THE PREVENTION AND TREATMENT OF GLUCOCORTICOID-INDUCED OSTEOPOROSISТоропцоваН. В.ToroptsovaN. V.

Наталья Владимировна Торопцова.

115522, Москва, Каширское шоссе, 34А

Natalia Toroptsova.

34A, Kashirskoe Shosse, Moscow 115522

torop@irramn.ruФГБНУ Научно-исследовательский институт ревматологии им. В.А. НасоновойРоссияV.A.Nasonova Research Institute of RheumatologyRussian Federation201807052018562144151Copyright © Торопцова Н.В., 20182018Торопцова Н.В.Toroptsova N.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/2518

Глюкокортикоиды (ГК) играют важную роль в лечении многих воспалительных заболеваний благодаря их противовоспалительной и иммуномодулирующей активности и используются во многих областях медицины. Несмотря на наличие клинических преимуществ при применении ГК у больных с хроническими воспалительными заболеваниями, длительный прием этих препаратов, особенно пероральный, часто вызывает развитие серьезных осложнений, таких как потеря костной массы и переломы. Настоящая статья посвящена обзору последних клинических рекомендаций Американской коллегии ревматологов (ACR) по профилактике и лечению глюкокортикоидного остеопороза, которые были опубликованы в 2017 г. Представлены комментарии с учетом российских рекомендаций по диагностике, профилактике и лечению глюкокортикоидного остеопороза.

Glucocorticoids (GCs) play an important role in treating many inflammatory diseases due to their anti-inflammatory and immunomodulatory activities and are used in many fields of medicine. Despite their clinical benefits of GCs used to treat patients with chronic inflammatory diseases, prolonged administration of these medications, especially oral ones, frequently causes serious complications, such as bone loss and fractures. The present paper reviews the latest American College of Rheumatology clinical guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis, which were published in 2017. It provides comments, by taking into account the Russian guidelines on the diagnosis, prevention, and treatment of glucocorticoid-induced osteoporosis.

клинические рекомендацииостеопорозглюкокортикоидыглюкокортикоидный остеопорозриск переломалечение глюкокортикоидного остеопорозаclinical guidelinesosteoporosisglucocorticoidsglucocorticoid-induced osteoporosisfracture risktreatment of glucocorticoid-induced osteoporosisReferencesHench PS, Kendall EC, Slocumb CH, Polley HF. The effect of a hormone of the adrenal cortex (17-hydroxy-11-dehydrocorticosterone: compound E) and of pituitary adrenocortical hormone in arthritis: preliminary report. Ann Rheum Dis. 1949 Jun;8 (2):97-104. doi: 10.1136/ard.8.2.97Hench PS, Kendall EC, Slocumb CH, Polley HF. The effect of a hormone of the adrenal cortex (17-hydroxy-11-dehydrocorticosterone: compound E) and of pituitary adrenocortical hormone in arthritis: preliminary report. Ann Rheum Dis. 1949 Jun;8 (2):97-104. doi: 10.1136/ard.8.2.97Pope JE, Hong P, Koehler BE. Prescribing trends in disease modifying antirheumatic drugs for rheumatoid arthritis: a survey of practicing Canadian rheumatologist. J Rheumatol. 2002;29:255-60.Pope JE, Hong P, Koehler BE. Prescribing trends in disease modifying antirheumatic drugs for rheumatoid arthritis: a survey of practicing Canadian rheumatologist. J Rheumatol. 2002;29:255-60.Thiele K, Buttgereit F, Huscher D, Zink A. Current use of glucocorticoids in patients with rheumatoid arthritis in Germany. Arthritis Rheum. 2005;53:740-7. doi: 10.1002/art.21467Thiele K, Buttgereit F, Huscher D, Zink A. Current use of glucocorticoids in patients with rheumatoid arthritis in Germany. Arthritis Rheum. 2005;53:740-7. doi: 10.1002/art.21467Sokka T, Kautiainen N, Toloza S, et al. QUEST-RA: quantitative clinical assessment of patients with rheumatoid arthritis seen in standard rheumatology care in 15 countries. Ann Rheum Dis. 2007;66:1491-6. doi: 10.1136/ard.2006.069252Sokka T, Kautiainen N, Toloza S, et al. QUEST-RA: quantitative clinical assessment of patients with rheumatoid arthritis seen in standard rheumatology care in 15 countries. Ann Rheum Dis. 2007;66:1491-6. doi: 10.1136/ard.2006.069252Kanis JA, Johansson H, Oden A, et al. A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res. 2004 Jun;19(6):893-9. doi: 10.1359/jbmr.040134Kanis JA, Johansson H, Oden A, et al. A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res. 2004 Jun;19(6):893-9. doi: 10.1359/jbmr.040134Fardet L, Petersen I, Nazareth I. Prevalence of long-term oral glucocorticoid prescriptions in UK over the past 20 years. Rheumatology (Oxford). 2011;50:1982-90. doi: 10.1093/rheumatology/ker017Fardet L, Petersen I, Nazareth I. Prevalence of long-term oral glucocorticoid prescriptions in UK over the past 20 years. Rheumatology (Oxford). 2011;50:1982-90. doi: 10.1093/rheumatology/ker017Van Staa TP, Leufkens HG, Abenhaim L, et al. Use of oral corticosteroids in the United Kingdom. QJM. 2000;93(2):105-11. doi: 10.1093/qjmed/93.2.105Van Staa TP, Leufkens HG, Abenhaim L, et al. Use of oral corticosteroids in the United Kingdom. QJM. 2000;93(2):105-11. doi: 10.1093/qjmed/93.2.105Баранова ИА, Ершова ОБ, Авдеева ОС и др. Первые результаты исследования по изучению состояния медицинской помощи с глюкокортикоидным остеопорозом и риском его развития (ГЛЮКОСТ). Материалы V Российского конгресса по остеопорозу и другим метаболическим заболеваниям скелета. Остеопороз и остеопатия. 2013;Прил.:120-1.Baranova IA, Ershova OB, Avdeeva OS, et al. The first results of a study on the state of medical care with glucocorticoid osteoporosis and the risk of its development (GLUCOST). Materials of the V Russian Congress on Osteoporosis and Other Metabolic Diseases of the Skeleton. Osteoporoz i Osteopatiya. 2013;Suppl:120-1 (In Russ.).Van Staa TP, Leufkens HG, Cooper C. The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int. 2002 Oct;13(10):777-87. doi: 10.1007/s001980200108Van Staa TP, Leufkens HG, Cooper C. The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int. 2002 Oct;13(10):777-87. doi: 10.1007/s001980200108Van Staa TP, Leufkens HG, Abenhaim L, et al. Use of oral corticosteroids and risk of fractures. J Bone Miner Res. 2000 Jun;15(6):993-1000. doi: 10.1359/jbmr.2000.15.6.993Van Staa TP, Leufkens HG, Abenhaim L, et al. Use of oral corticosteroids and risk of fractures. J Bone Miner Res. 2000 Jun;15(6):993-1000. doi: 10.1359/jbmr.2000.15.6.993Curtis J, Westfall AO, Allison J, et al. Population-based assessment of adverse events associated with long-term glucocorticoid use. Arthritis Rheum. 2006;55:420-6. doi: 10.1002/art.21984Curtis J, Westfall AO, Allison J, et al. Population-based assessment of adverse events associated with long-term glucocorticoid use. Arthritis Rheum. 2006;55:420-6. doi: 10.1002/art.21984Angeli A, Guglielmi G, Dovio A, et al. High prevalence of asymptomatic vertebral fractures in post-menopausal women receiving chronic glucocorticoid therapy: a cross-sectional outpatient study. Bone. 2006;39:253-9. doi: 10.1016/j.bone.2006.02.005Angeli A, Guglielmi G, Dovio A, et al. High prevalence of asymptomatic vertebral fractures in post-menopausal women receiving chronic glucocorticoid therapy: a cross-sectional outpatient study. Bone. 2006;39:253-9. doi: 10.1016/j.bone.2006.02.005Van Staa TP, Leufkens HG, Abenhaim L, et al. Oral corticosteroids and fracture risk: relationship to daily and cumulative doses. Rheumatology (Oxford). 2000 Dec;39(12):1383-9. doi: 10.1093/rheumatology/39.12.1383Van Staa TP, Leufkens HG, Abenhaim L, et al. Oral corticosteroids and fracture risk: relationship to daily and cumulative doses. Rheumatology (Oxford). 2000 Dec;39(12):1383-9. doi: 10.1093/rheumatology/39.12.1383Laan RF, van Riel PL, van de Putte LB, et al. Low-dose prednisone induces rapid reversible axial bone loss in patients with rheumatoid arthritis: a randomized, controlled study. Ann Intern Med. 1993;119:963-8. doi: 10.7326/0003-4819-119-10-199311150-00001Laan RF, van Riel PL, van de Putte LB, et al. Low-dose prednisone induces rapid reversible axial bone loss in patients with rheumatoid arthritis: a randomized, controlled study. Ann Intern Med. 1993;119:963-8. doi: 10.7326/0003-4819-119-10-199311150-00001Hansen KE, Kleker B, Safdar N, Bartels CM. A systematic review and meta-analysis of glucocorticoid-induced osteoporosis in children. Semin Arthritis Rheum. 2014;44:47-54. doi: 10.1016/j.semarthrit.2014.02.002Hansen KE, Kleker B, Safdar N, Bartels CM. A systematic review and meta-analysis of glucocorticoid-induced osteoporosis in children. Semin Arthritis Rheum. 2014;44:47-54. doi: 10.1016/j.semarthrit.2014.02.002LeBlanc CM, Ma J, Taljaard M, et al. Incident vertebral fractures and risk factors in the first three years following glucocorticoid initiation among pediatric patients with rheumatic disorders. J Bone Miner Res. 2015;30:1667-75. doi: 10.1002/jbmr.2511LeBlanc CM, Ma J, Taljaard M, et al. Incident vertebral fractures and risk factors in the first three years following glucocorticoid initiation among pediatric patients with rheumatic disorders. J Bone Miner Res. 2015;30:1667-75. doi: 10.1002/jbmr.2511Hall GM, Spector TD, Griffin AJ, et al. The effect of rheumatoid arthritis and steroid therapy on bone density in postmenopausal women. Arthritis Rheum. 1993;36:1510-6. doi: 10.1002/art.1780361105Hall GM, Spector TD, Griffin AJ, et al. The effect of rheumatoid arthritis and steroid therapy on bone density in postmenopausal women. Arthritis Rheum. 1993;36:1510-6. doi: 10.1002/art.1780361105Sugiyama T, Suzuki S, Yoshida T, et al. Incidence of symptomatic vertebral fractures in women of childbearing age newly treated with high-dose glucocorticoid. Gend Med. 2010;7:218-29. doi: 10.1016/j.genm.2010.06.004Sugiyama T, Suzuki S, Yoshida T, et al. Incidence of symptomatic vertebral fractures in women of childbearing age newly treated with high-dose glucocorticoid. Gend Med. 2010;7:218-29. doi: 10.1016/j.genm.2010.06.004Li EK, Tam LS, Griffith JF, et al. High prevalence of asymptomatic vertebral fractures in Chinese women with systemic lupus erythematosus. J Rheumatol. 2009;36:1646-52. doi: 10.3899/jrheum.081337Li EK, Tam LS, Griffith JF, et al. High prevalence of asymptomatic vertebral fractures in Chinese women with systemic lupus erythematosus. J Rheumatol. 2009;36:1646-52. doi: 10.3899/jrheum.081337Borba VZ, Matos PG, da Silva Viana PR, et al. High prevalence of vertebral deformity in premenopausal systemic lupus erythematosus patients. Lupus. 2005;14:529-33. doi: 10.1191/0961203305lu2154oaBorba VZ, Matos PG, da Silva Viana PR, et al. High prevalence of vertebral deformity in premenopausal systemic lupus erythematosus patients. Lupus. 2005;14:529-33. doi: 10.1191/0961203305lu2154oaБаранова ИА, Ершова ОБ, Анаев ЭХ и др. Анализ оказания консультативной медицинской помощи пациентам сглюкокортикоидным остеопорозом или риском его развития по данным анкетирования пациентов (исследование ГЛЮКОСТ). Терапевтический архив. 2015;(5):58-64. doi: 10.17116/terarkh201587558-64Baranova IA, Ershova OB, Anaev EKh, et al. Analysis of the state-of-the-art of consulting medical care to patients with glucocorticoid-induced osteoporosis or its risk according to the data of a questionnaire survey (GLUCOST study). Terapevticheskii Arkhiv. 2015;(5):58-64 (In Russ.). doi: 10.17116/terarkh201587558-64Buckley L, Guyatt G, Fink HA, et al. 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. Arthritis Rheum. 2017;69(8):1521-37. doi: 10.1002/art.40137Buckley L, Guyatt G, Fink HA, et al. 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. Arthritis Rheum. 2017;69(8):1521-37. doi: 10.1002/art.40137Kanis JA, Johansson H, Oden A, McCloskey EV. Guidance for the adjustment of FRAX according to the dose of glucocorticoids. Osteoporos Int. 2011;22:809-16. doi: 10.1007/s00198-010-1524-7Kanis JA, Johansson H, Oden A, McCloskey EV. Guidance for the adjustment of FRAX according to the dose of glucocorticoids. Osteoporos Int. 2011;22:809-16. doi: 10.1007/s00198-010-1524-7Grossman JM, Gordon R, Ranganath VK, et al. American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res (Hoboken). 2010;62:1515-26. doi: 10.1002/acr.20295Grossman JM, Gordon R, Ranganath VK, et al. American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res (Hoboken). 2010;62:1515-26. doi: 10.1002/acr.20295Dawson-Hughes B, Tosteson AN, Melton LJ III, et al. Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA. Osteoporos Int. 2008;19:449-58. doi: 10.1007/s00198-008-0559-5Dawson-Hughes B, Tosteson AN, Melton LJ III, et al. Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA. Osteoporos Int. 2008;19:449-58. doi: 10.1007/s00198-008-0559-5Kanis JA, McCloskey EV, Johansson H, et al. Development and use of FRAX in osteoporosis. Osteoporos Int. 2010;21 Suppl 2(S2):S407-13. doi: 10.1007/s00198-010-1253-yKanis JA, McCloskey EV, Johansson H, et al. Development and use of FRAX in osteoporosis. Osteoporos Int. 2010;21 Suppl 2(S2):S407-13. doi: 10.1007/s00198-010-1253-yБаранова ИА, Белая ЖЕ, Гассер РВ и др. Остеопороз: Руководство для врачей. Москва; 2016. 464 с. [Baranova IA, Belaya ZhE, Gasser RV, et al. Osteoporoz: Rukovodstvo dlya vrachei.Baranova IA, Belaya ZhE, Gasser RV, et al. Osteoporoz: Rukovodstvo dlya vrachei [Osteoporosis: A guide for doctors]. Moscow; 2016. 464 p. (In Russ.).Торопцова НВ, Баранова ИА. Глюкокортикоидный остеопороз: особенности терапии. Современная ревматология. 2013;7(4):33-7. doi: 10.14412/1996-7012-2013-2436Торопцова НВ, Баранова ИА. Глюкокортикоидный остеопороз: особенности терапии. Современная ревматология. 2013;7(4):33-7 [Toroptsova NV, Baranova IA. Glucocorticoid osteoporosis; osteoporotic fracture; bisphosphonates. Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2013;7(4):33-7 (In Russ.)]. doi: 10.14412/1996-7012-2013-2436Holick MF. Optimal vitamin D status for the prevention and treatment of osteoporosis. Drugs Aging. 2007;24:1017-29. doi: 10.2165/00002512-200724120-00005Holick MF. Optimal vitamin D status for the prevention and treatment of osteoporosis. Drugs Aging. 2007;24:1017-29. doi: 10.2165/00002512-200724120-00005Белая ЖЕ, Белова КЮ, Бордакова ЕВ и др. Профилактика, диагностика и лечение дефицита витамина D и кальция среди взрослого населения и у пациентов с остеопорозом. Рекомендации Российской ассоциации по остеопорозу. Москва: ГЭОТАР-Медиа; 2016. 96 с.Belaya ZhE, Belova KYu, Bordakova EV, et al. Profilaktika, diagnostika i lechenie defitsita vitamina D i kal'tsiya sredi vzroslogo naseleniya i u patsientov s osteoporozom. Rekomendatsii Rossiiskoi assotsiatsii po osteoporozu [Prophylaxis, diagnosis and treatment of vitamin D and calcium deficiency in the adult population and in patients with osteoporosis. Recommendations of the Russian Association for Osteoporosis]. Moscow: GEOTAR-Media; 2016. 96 p. (In Russ.).De Nijs RN, Jacobs JW, Algra A, et al. Prevention and treatment of glucocorticoid-induced osteoporosis with active vitamin D3 analogues: a review with meta-analysis of randomized controlled trials including organ transplantation studies. Osteoporos Int. 2004;15(8):589-602. doi: 10.1007/s00198-004-1614-5De Nijs RN, Jacobs JW, Algra A, et al. Prevention and treatment of glucocorticoid-induced osteoporosis with active vitamin D3 analogues: a review with meta-analysis of randomized controlled trials including organ transplantation studies. Osteoporos Int. 2004;15(8):589-602. doi: 10.1007/s00198-004-1614-5Hoes JN, Jacobs JW, Hulsmans HM, et al. High incidence rate of vertebral fractures during chronic prednisone treatment, in spite of bisphosphonate or alfacalcidol use. Extension of the alendronate or alfacalcidol in glucocorticoid-induced osteoporosis-trial. Clin Exp Rheumatol. 2010;28(3):354-9.Hoes JN, Jacobs JW, Hulsmans HM, et al. High incidence rate of vertebral fractures during chronic prednisone treatment, in spite of bisphosphonate or alfacalcidol use. Extension of the alendronate or alfacalcidol in glucocorticoid-induced osteoporosis-trial. Clin Exp Rheumatol. 2010;28(3):354-9.

The authors declare that there are no conflicts of interest present.