Use of oral corticosteroids in the community and the prevention of secondary osteoporosis: a cross sectional study

Abstract

Objective-To determine the prevalence of continuous use of oral steroids in the general population, the conditions for which they are prescribed, and the extent to which patients taking oral steroids are taking treatment to prevent osteoporosis.Design-A cross sectional study with a four year retrospective review of drug treatment.Setting-Eight large general practices in central and southern Nottinghamshire.Subjects-A population of 65 786 patients (52% women) registered with a general practitioner during 1995.Results-303 patients (65% (197) women) aged 12-94 years were currently taking "continuous" (for at least three months) oral corticosteroid treatment. This figure represents 0.5% of the total population and 1.4% (245/17 114) of patients aged 55 years or more (1.7% (16619601) of women). The usual steroid was prednisolone (97% (294/303)), the mean dose was 8.0 mg/day, and the median duration of oral steroid treatment determined in 149 patients was three years. The most common conditions for which continuous oral steroids were prescribed were rheumatoid arthritis (23% (70)), polymyalgia rheumatica (22% (66)), and asthma or chronic obstructive airways disease (190%o (59)). Only 41 (14%) of the 303 patients taking oral steroids had received treatment for the prevention of osteoporosis over the past four years. Although 37 ofthe 41 patients were women, only 10% (181181) of the women over 45 years taking continuous oral corticosteroids were currently taking hormone replacement therapy.Conclusions-If our figures are typical then they suggest that over 250 000 people in the United Kingdom are taking continuous oral steroids and that most of these are taking no prophylaxis against osteoporosis.

Corticosteroid use and risk of hip fracture: a population‐based case–control study in Denmark

“…The high frequency of ever CS users (11% in controls vs. 0.9% current users in the study by van Staa et al [3]) was due to the advanced age of the case and thus also control subjects. The use of CS increases with age [2], and the mean age of 78 years was much higher than in previous population-based studies [2,3]. Furthermore, previous studies report current use (prevalence) whereas the present study reports ever (cumulated) use.…”

“…Two recent cross-sectional drug-utilization studies from the UK have reported a high prevalence of CS use of 0.5% [2] and 0.9% [3], respectively. The prevalence of CS users increased with age: 1.4% of all subjects aged ‡55 years had used CS for more than 3 months [2].…”

“…The prevalence of CS users increased with age: 1.4% of all subjects aged ‡55 years had used CS for more than 3 months [2]. The widespread use may have a major public-health impact because of the risk of adverse events including CS-induced osteoporosis [1,4].…”

Current use of glucocorticoids in patients with rheumatoid arthritis in Germany

“…Community survey data estimate the frequency of oral glucocorticoid use as 0.5% of the general population and 1.75% of women Ͼ55 years of age (1,2). Glucocorticoids still play a decisive role in the management of diverse rheumatic conditions due to their powerful antiinflammatory and immunosuppressive properties.…”

Corticosteroid-induced osteoporosis in patients with uveitis

“…A 1997 survey of consultant ophthalmologists 1 showed that three quarters prescribed steroids in significant doses but that only 25% of these gave advice to patients on the prevention of osteoporosis. A 1999 study in general practice 2 showed that only 14% of steroid users were prescribed prophylactic treatment against bone loss. Although the literature on steroidinduced osteoporosis is now extensive, it has been largely confined to the rheumatological and specialist medical literature.…”