Use of corticosteroids and bone‐active medications in clinical practice

Abstract

Aim: To assess the quality of care of patients beginning corticosteroid therapy with respect to bone protection. Methods: Practicing rheumatologists in Australia were approached countrywide to recruit patients beginning corticosteroid therapy under their care. Use of bone‐active medications in the ensuing year was recorded prospectively. Baseline and follow‐up bone mineral density and fracture data were collected. Results: Ninety‐two patients (64% female) were enrolled by 18 rheumatologists. Seven patients reported a medical history of osteoporosis and 14 had already sustained a low‐trauma fracture. The median corticosteroid dose at commencement of therapy was 20 mg of prednisone. Bone‐active medications were commenced in 47% of patients within 3 months of commencing steroid therapy. These included calcium supplements (33%), vitamin D supplements (21%), hormone replacement therapy (11%), selective estrogen receptor antagonists (5%) and bisphosphonates (15%). Calcium and vitamin D supplementation usually accompanied bisphosphonate therapy. Median change in bone mineral density at the lumbar spine was −0.20 SD units over 12 months (range: −1.16–0.70, P = 0.007), and at the hip −0.10 SD units over 12 months (range −1.66–0.93, P = 0.24). There were 21 new fractures in 13 patients over the study period, with a vertebral fracture incidence of 0.16 per patient year. Of those patients taking bisphosphonate therapy, two had incident low‐trauma fractures but there was no significant change in bone mineral density at the hip or spine. Conclusions: Rheumatologists in Australia appear informed about the need for bone‐active medications in patients who are commencing steroid therapy. However there remains room for improved awareness, as is seen by the low use of bisphosphonates.

Glucocorticoid-Induced Osteoporosis

“…Zajedni~ko propisivanje aktivnih lijekova u klini~koj praksi zabilje`ena je u 4 % do 48 % slu~ajeva, a bisfosfonata u 0,5 % do 9 %. Reumatolozi znatno odska~u u propisivanju aktivnih lijekova ~ine}i to u 58 % do 61 % slu~ajeva (31). Glukokortikoidna osteoporoza je znatan medicinski problem, razli~it u dijagnosti~kom i terapijskom smislu od postmenopauzalne osteoporoze, pa je potrebno i u nas dogovoriti preporuke za dijagnostiku, prevenciju i lije~enje.…”