Prevalence of long term steroid treatment and the frequency of decision making to prevent steroid induced osteoporosis in daily clinical practice

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ls of the Rheumatic Diseases 2002;61:32-36

© 2002 by ls of the Rheumatic Diseases

Prevalence of long term steroid treatment and the frequency of decision

making to prevent steroid induced osteoporosis in daily clinical

practice

B Gudbjornsson1,3, U I Juliusson1 and F V Gudjonsson2

1 The Regional Hospital, Akureyri, Iceland

2 Health Care Centre, Akureyri, Iceland

3 Centre for Rheumatology Research, University Hospital, Iceland

Correspondence to:

Dr B Gudbjornsson, Centre for Rheumatology Research, University

Hospital, 101 Reykjavik, Iceland;

bjorngu@...

Background: The use of oral corticosteroids (CS) is one of the most

common causes of iatrogenic osteoporosis. Recently, therapeutic

guidelines dealing with the skeletal complication of CS have been

published.

Objective: To evaluate how CS are used in the community and the

frequency of active intervention against corticosteroid induced

osteoporosis in daily clinical practice.

Material and methods: After approval by the Committee on Medical Ethics

and the Data Protection Commission all prescriptions for CS which were

filled by pharmacies in the northeast area of Iceland (population 26

664) during a two year period were collected. Thereafter, clinical

information was obtained from medical records at the healthcare centres

and from the local hospital. Patients who were taking CS for at least

three months a year or for repeated periods (for a total of three months

annually) were included in the study. These patients also received a

questionnaire about hormone replacement therapy, bisphosphonates, and

dietary consumption of calcium and vitamin D.

Results: A total of 191 patients were included in the study or 0.7% of

the population. Their mean age was 66 years (17-93) and 106/191 (55%)

were women. Only 63 (33%) patients had no registered complication due to

the treatment, according their medical records. Thirty nine (20%)

patients had had an osteoporosis related fracture and 50 (26%) of the

patients had presumed CS induced osteoporosis. A total of 52% patients

were receiving supplementary vitamin D (fish liver oil) and 37% were

taking calcium tablets regularly, while 91% of the patient group were

consuming milk products regularly. Only 17 (9%) patients were taking

bisphosphonates and 18/81 (22%) of the postmenopausal women were

receiving hormone replacement therapy.

Conclusions: Relatively few patients receiving long term treatment with

CS are also receiving primary prevention against CS induced

osteoporosis, although several patients are taking vitamin D and calcium

tablets. Specific treatment against osteoporosis was in most cases

instituted secondary to osteoporotic complications. Thus although there

are available treatment alternatives against CS induced osteoporosis,

the doctors who prescribed CS did not make use of this form of treatment

for their patients.

***** 's note: This is an interesting paragraph from the full text

version of this study:

The bone loss associated with CS is most rapid early in the treatment

phase.24 Thus 15% of those subjects who are in need of long term

treatment with CS can expect a vertebral fracture in their first year of

treatment.25 CS not only reduce the bone mineral density but also

influence the microarchitecture of the bone, which results in a further

increase of the risk of fracture.7,26,27 In this context, it has been

proposed that patients receiving CS who have a bone density with a T

score value of less than -1.5SD (the difference in standard deviation

(SD) with respect to the peak bone mass in a young adult of the same

race and sex), as measured by DEXA, should be classified as having

osteoporosis, instead of a T score of less than -2.5SD, as currently

recommended for the diagnosis of postmenopausal osteoporosis.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

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