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

Abstract

-Glucocorticoids are associated with increased risk of bone loss and fracture. This study compared the prescribing of bone protective agents by rheumatologists in clinical practice with the standards recommended in the 1998 UK Consensus guidelines. All glucocorticoid users who attended rheumatology outpatients during a four-week period were eligible. Notes were audited according to a predefined proforma. Among the 1,290 rheumatology outpatients seen in the study period, 189 (15%) were taking glucocorticoids. 63% of glucocorticoid patients were taking calcium and 46% vitamin D. In total, 124 (71%) of the 175 patients available for review were at high risk of osteoporotic fracture, of whom 76 (61%) were taking appropriate prophylaxis. In 26 (15%) patients, insufficient information was available to be able to quantify the risk of fracture. The study showed that the audit standard was not met in 39% of cases. A better strategy for the monitoring of clinical risk factors is therefore required.

Glucocorticoid‐induced osteoporosis: unawareness or negligence in India?

“…In the present study 55.2% of subjects were prescribed at least one intervention to prevent osteoporosis (DEXA, calcium supplementation, vitamin D or bisphosphonates), this was close to the audit done by Yood et al. where it was 62%, 10 while in a study by Walker Bone 61% patients were receiving appropriate prophylaxis 11 . Lozsadi and his team also had assessed their neurology patients for the same thing and in that study 40% were given bisphosphonates, while 21% had received hormone replacement therapy 12 …”

Use of corticosteroids and bone‐active medications in clinical practice

“…Rheumatologists have been shown to be better at initiating GIOP prophylaxis and treatment than other specialists, 21,31 likely due to frequent corticosteroid prescription in daily practice and a higher awareness of osteoporosis 32 . Smaller studies of co‐prescription of bone‐active medications with corticosteroids in rheumatology outpatient clinics show better uptake of best practice, with rates of 58–61% 33 , 34 . Thus it would be expected that a prospective survey of rheumatological practice would show a relatively high rate of GIOP prophylaxis and treatment.…”

Audits of the prevention and treatment of corticosteroid-induced osteoporosis in outpatients with rheumatic diseases in the West Midlands

“…In this study, flow charts summarising the guidelines were posted in every clinic room. 4 A similar audit in a group of general medical inpatients found that only 35.3% were treated appropriately. 5 The results relating to the 2002 Guidelines suggest poorer performance.…”

“…Several other studies have demonstrated a significant discrepancy between guidance and prescribing patterns for both corticosteroidinduced [3][4][5][6] and postmenopausal osteoporosis. 15,16 Poor adherence to the guidelines may be a result of a number of factors, including the perceived strength of the evidence base supporting the guidance, support from relevant professional bodies and availability of resources and funding.…”

“…Previous studies indicate that significant numbers of at-risk patients are not receiving therapy to prevent bone loss. [3][4][5][6] Ongoing evaluation of the implementation of management strategies for the prevention of fracture for patients on corticosteroids is therefore crucially important.…”