Steroid induced osteoporosis: an opportunity for prevention?

Abstract

Objective-To determine the frequency with which osteoporosis prophylaxis is given to corticosteroid treated hospital inpatients. Methods-All patients receiving systemic corticosteroids in a large teaching hospital over a three month period were identified through routine prescription monitoring by hospital ward pharmacists. Coprescription of antiosteoporotic therapy was recorded, along with other relevant details such as steroid dose, actual, or intended duration of therapy, and indication for therapy. Results-Corticosteroids were prescribed to 214 patients over the study period, giving an average rate of 25 new prescriptions each day. Indications included: chest disease (n = 84; 39.2%), cancer (n = 17; 7'9%), inflammatory bowel disease (n = 16; 7/5%), rheumatoid arthritis/connective tissue disease (n = 16; 7.5O/), and renal diseases (n = 7; 3 3/3%). One hundred and twelve patients (52.3%) were receiving short term steroid therapy (less than four months); 66 (37%) were receiving medium/long term steroid therapy (four months or more). In 36 cases (16.8%) the duration of therapy was unknown. Only 12 of the 214 patients (5.6%) received any form of osteoporosis prophylaxis. The prevalence of prophylaxis was similarly low in postmenopausal women (six of 93; 6.4%) and in patients receiving high dose long term steroid therapy (two of 25; 8%). Conclusions-Systemic corticosteroids are used frequently in hospital practice for a wide range of indications, but few patients receive co-prescription of prophylaxis against osteoporosis. This is true even in high risk groups such as postmenopausal women and those on high dose long term steroid therapy. Identification of individuals by the mechanism used in this study provides an opportunity by which all corticosteroid treated patients could be detected and offered osteoporosis prophylaxis before serious loss ofbone density has occurred.

Longitudinal patterns in the prevention of osteoporosis in glucocorticoid‐treated patients

“…However, similar to findings in our prior study and other US and international studies (11,12,(20)(21)(22)(23)(24), we found low utilization rates and significant practice pattern variation between physician specialties in screening and preventive therapies for glucocorticoid-induced osteoporosis. We also found significant variation between prescribing physician specialties in the proportion of their patients taking OTC calcium or vitamin D supplements.…”

The prevention and treatment of glucocorticoid-induced osteoporosis in clinical practice

“…Compared with the findings among glucocorticoid users in the general population, [4][5]8 ophthalmology clinics, 13 medical wards 7,11 and medical outpatient clinics, 14 the results of this study suggest that rheumatology outpatients receiving glucocorticoids were more likely to have been offered bone density measurement and/or prophylactic treatment. It appears that practising rheumatologists have a generally higher level of awareness of glucocorticoid-induced osteoporosis and are more likely to evaluate risk and consider appropriate bone-sparing therapy.…”

“…Previous studies have shown that the vast majority of glucocorticoid-treated patients have not been evaluated for osteoporosis risk or commenced on treatment to prevent accelerated bone loss and future fracture. [8][9][10][11][12][13][14][15] Rheumatologists are among those with the greatest experience of glucocorticoid therapy, and are also most likely to report that they would prescribe preventive therapy. 16 A survey of medical inpatients in Australia suggested that rheumatological patients taking glucocorticoids were more likely to have been offered bone density screening and/or prophylactic treatment than were similar patients with respiratory disease.…”

Cross-sectional Study of Bisphosphonate Use in Dermatology Patients Receiving Long-term Oral Corticosteroid Therapy

“…These findings are consistent with those from studies in other medical specialties in which bisphosphonates were rarely prescribed. [18][19][20][21] In a British study by Hart and Green, 19 bisphosphonates were prescribed at a rate of 21.6% for patients who qualified for GIOP prophylaxis. Two other studies from the United States showed that bisphosphonates were received by only 4% and 8% of patients, respectively, prior to the revision of the ACR guidelines.…”