Is enough attention being given to the adverse effects of corticosteroid therapy?

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J Clin Pharm Ther 2000 Jun;25(3):227-34

Is enough attention being given to the adverse effects of

corticosteroid therapy?

Hougardy DM, GM, Bleasel MD, Randall CT.

Tasmanian School of Pharmacy, Faculty of Health Science, University

of Tasmania, Tasmania, Australia.

BACKGROUND: Although the corticosteroids are valuable

anti-inflammatory and immunosuppressive agents, they also possess

many potential adverse effects, especially with continued use. In

particular, long-term corticosteroid exposure carries a significant

risk of osteoporosis. AIM: To review the use of corticosteroids in

patients presenting to the major teaching hospital in Tasmania,

Australia; principally to determine whether patients receiving

long-term corticosteroid therapy were being monitored for loss of

bone mineral density and offered preventive therapy for

osteoporosis. METHODS: A retrospective review of the medical records

for 212 consecutive patients admitted to the medical wards of the

hospital over a 5-month period and receiving treatment with either

oral or inhaled corticosteroids, was performed. An extensive range

of demographic and clinical variables was recorded for each patient.

Patients were also questioned about diet and exercise, and whether

they had undergone tests for measuring bone mineral density or blood

glucose. RESULTS: The median age of the patients was 69 years

(range: 15-90 years) and 58% were female. Over half (53%) of the

patients were on oral corticosteroids only, with 26% using inhaled

corticosteroids only, and 21% on both oral and inhaled

corticosteroid therapy. The most common conditions for which

patients were receiving corticosteroid therapy were asthma (37% of

patients), chronic obstructive pulmonary disease (33%) and

rheumatoid arthritis (17%). The most commonly used oral

corticosteroid was prednisolone (93%), the median daily dose was 10

mg prednisolone equivalent, and the median duration of oral

corticosteroid treatment was 50 weeks. Disregarding short courses,

the median duration of oral corticosteroid treatment was 104 weeks.

Almost one-third (31%) of the patients receiving oral corticosteroid

treatment had been taking the equivalent of 7.5 mg prednisolone

daily for at least 6 months. Only 11% of all patients on oral

corticosteroids and 21% of those who had been taking oral

corticosteroids for at least one year had documented evidence of

bone mineral density testing being performed in the past in the

hospital. Only 21% of all patients on oral corticosteroids and 31%

of those who had been taking oral corticosteroids for at least one

year were receiving medication for osteoporosis prevention, and only

15% of women over 45 years of age and on oral corticosteroid therapy

were taking hormone replacement therapy. Only about half of the

patients on long-term systemic corticosteroid therapy had either

documented evidence in their hospital medical records, or were

aware, of having undergone blood glucose testing in the preceding 12

months. CONCLUSION: More attention to the prevention and monitoring

of possible adverse effects of long-term corticosteroid therapy is

warranted. Guidelines covering preventive measures and treatment

options for corticosteroid-induced osteoporosis need to be

considered routinely when using these agents.

PMID: 10886467 [PubMed - indexed for MEDLINE]