The 2023 Guidelines for the management and treatment of glucocorticoid-induced osteoporosis.

INTRODUCTION: Although synthetic glucocorticoids (GCs) are commonly used to treat autoimmune and other diseases, GC induced osteoporosis (GIOP) which accounts for 25% of the adverse reactions, causes fractures in 30-50% of patients, and markedly decreases their quality of life. In 2014, the Japanese Society for Bone and Mineral Research (JSBMR) published the revised guidelines for the management and treatment of steroid-induced osteoporosis, providing the treatment criteria based on scores of risk factors, including previous fractures, age, GC doses, and bone mineral density, for patients aged ≥18 years who are receiving GC therapy or scheduled to receive GC therapy for ≥3 months. MATERIALS AND METHODS: The Committee on the revision of the guidelines for the management and treatment of GIOP of the JSBMR prepared 17 clinical questions (CQs) according to the GRADE approach and revised the guidelines for the management and treatment of GIOP through systematic reviews and consensus conferences using the Delphi method. RESULTS: Bisphosphonates (oral and injectable formulations), anti-RANKL antibody teriparatide, eldecalcitol, or selective estrogen receptor modulators are recommended for patients who has received or scheduled for GC therapy with risk factor scores of ≥3. It is recommended that osteoporosis medication is started concomitantly with the GC therapy for the prevention of fragility fractures in elderly patients. CONCLUSION: The 2023 guidelines for the management and treatment of GIOP was developed through systematic reviews and consensus conferences using the Delphi method.

Systemic lupus erythematosus with repeated protein-losing enteropathy resulting from different pathological conditions: a case report.

Protein-losing enteropathy (PLE) is a rare organ disorder that can develop as a complication of systemic lupus erythematosus (SLE). Here, we report the case of a 59-year-old woman with SLE who experienced recurrent PLE resulting from different pathological conditions. The patient was diagnosed with SLE in X-14. In X-12, she was hospitalised due to persistent diarrhoea, generalised oedema, abdominal distension, dyspnoea on exertion, and hypoalbuminemia. A thrombus was noted in the superior mesenteric vein extending from the main trunk of the portal vein. She was diagnosed with PLE resulting from portal vein thrombosis caused by SLE, and her condition improved with anticoagulant therapy. In X-1, she developed diarrhoea and hypoalbuminemia again and was diagnosed with PLE associated with SLE. The symptoms promptly ameliorated with immunosuppressive therapy. Because PLE associated with SLE can be caused by various pathological conditions, appropriate therapeutic intervention based on the underlying condition is crucial.