RESEARCH - Use of bisphosphonates and DEXA scans in the prevention and treatment of steroid-induced osteoporosis in rheumatology

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QJM. 2008 Apr;101(4):317-23. Epub 2008 Feb 12.

Use of bisphosphonates and dual-energy X-ray absorptiometry scans in

the prevention and treatment of glucocorticoid-induced osteoporosis in

rheumatology.

Wall E, -Bone K.

Brighton & Sussex Medical School, Education Centre, Princess Royal

Hospital, Lewes Road, Haywards Heath, West Sussex, RH16 4EX, UK.

BACKGROUND: Patients treated with steroids are at risk of

glucocorticoid-induced osteoporosis. Appropriate investigations and

therapeutic agents can decrease rate of bone loss and fracture. AIM:

To review adherence to current UK guidelines for the prevention of

glucocorticoid-induced osteoporosis in rheumatology outpatient

clinics. DESIGN: Retrospective case note review. METHODS: The

management of patients taking glucocorticoids who attended outpatient

rheumatology clinics at a Teaching Hospital NHS Trust over a 4-week

period was reviewed against current UK recommendations for prevention

and treatment of osteoporosis (Bone and Tooth Society, National

Osteoporosis Society, Royal College of Physicians.

Glucocorticoid-induced osteoporosis: guidelines for prevention and

treatment. London: Royal College Physicians, 2002). RESULTS: Over the

study period, 519 patients attended rheumatology outpatient clinics,

amongst whom 104 were current glucocorticoid users. Most patients had

been taking oral steroids for over 12 months (n = 79, 76%). The

majority had also received steroids by at least one other route (n =

67, 64.4%). According to the guidelines, 51 patients, at relatively

low risk of osteoporosis (<65 years, no previous fragility fracture)

should have been referred for bone density assessment; of these, 27

(53%) had received a DEXA scan. In total, 58 subjects fulfilled

criteria for bisphosphonates (>65 years, fragility fracture, T-score

<-1.5) and, of these, 51 (87.9%) were appropriately treated. In 21

cases, a DEXA scan had been performed when guidelines recommended that

treatment could commence without further assessment.

DISCUSSION: The findings indicate a high level of awareness of

glucocorticoid-induced osteoporosis amongst UK rheumatologists. Most

patients identified to be at high risk of bone loss were offered

treatment. Although encouraging, current practice could potentially be

improved, particularly through more targeted use of DEXA scanning.

PMID: 18270228

http://www.ncbi.nlm.nih.gov/pubmed/18270228

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