EXTENDED REPORT

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

B Gudbjornsson^1,3, U I Juliusson¹, 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:
Correspondence to:
Dr B Gudbjornsson, Centre for Rheumatology Research, University Hospital, 101 Reykjavik, Iceland;
bjorngu{at}landspitali.is

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.

Keywords: community; glucocorticosteroids; osteoporosis; prevalence; prevention

Abbreviations: CS, corticosteroids; DEXA, dual x ray absorption; HRT, hormone replacement therapy

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Kola, B., Christ-Crain, M., Lolli, F., Arnaldi, G., Giacchetti, G., Boscaro, M., Grossman, A. B., Korbonits, M. (2008). Changes in Adenosine 5'-Monophosphate-Activated Protein Kinase as a Mechanism of Visceral Obesity in Cushing's Syndrome. J. Clin. Endocrinol. Metab. 93: 4969-4973 [Abstract] [Full Text]  
• Christ-Crain, M., Kola, B., Lolli, F., Fekete, C., Seboek, D., Wittmann, G., Feltrin, D., Igreja, S. C., Ajodha, S., Harvey-White, J., Kunos, G., Muller, B., Pralong, F., Aubert, G., Arnaldi, G., Giacchetti, G., Boscaro, M., Grossman, A. B., Korbonits, M. (2008). AMP-activated protein kinase mediates glucocorticoid-induced metabolic changes: a novel mechanism in Cushing's syndrome. FASEB J. 22: 1672-1683 [Abstract] [Full Text]  
• Kinjo, M., Setoguchi, S., Solomon, D. H. (2007). Bone Mineral Density in Adults with the Metabolic Syndrome: Analysis in a Population-Based U.S. Sample. J. Clin. Endocrinol. Metab. 92: 4161-4164 [Abstract] [Full Text]  
• Galluzzi, F., Stagi, S., Salti, R., Toni, S., Piscitelli, E., Simonini, G., Falcini, F., Chiarelli, F. (2005). Osteoprotegerin serum levels in children with type 1 diabetes: a potential modulating role in bone status. Eur J Endocrinol 153: 879-885 [Abstract] [Full Text]  
• Solomon, D. H., Morris, C., Cheng, H., Cabral, D., Katz, J. N., Finkelstein, J. S., Avorn, J. (2005). Medication Use Patterns for Osteoporosis: An Assessment of Guidelines, Treatment Rates, and Quality Improvement Interventions. Mayo Clin Proc. 80: 194-202 [Abstract]  
• Capell, H A, Madhok, R, Hunter, J A, Porter, D, Morrison, E, Larkin, J, Thomson, E A, Hampson, R, Poon, F W (2004). Lack of radiological and clinical benefit over two years of low dose prednisolone for rheumatoid arthritis: results of a randomised controlled trial. Ann Rheum Dis 63: 797-803 [Abstract] [Full Text]  
• Lerner, U. H. (2004). NEW MOLECULES IN THE TUMOR NECROSIS FACTOR LIGAND AND RECEPTOR SUPERFAMILIES WITH IMPORTANCE FOR PHYSIOLOGICAL AND PATHOLOGICAL BONE RESORPTION. CROBM 15: 64-81 [Abstract] [Full Text]  
• Cheng, X., Kinosaki, M., Takami, M., Choi, Y., Zhang, H., Murali, R. (2004). Disabling of Receptor Activator of Nuclear Factor-{kappa}B (RANK) Receptor Complex by Novel Osteoprotegerin-like Peptidomimetics Restores Bone Loss in Vivo. J. Biol. Chem. 279: 8269-8277 [Abstract] [Full Text]  
• Dolan, A L, Koshy, E, Waker, M, Goble, C M (2004). Access to bone densitometry increases general practitioners' prescribing for osteoporosis in steroid treated patients. Ann Rheum Dis 63: 183-186 [Abstract] [Full Text]  
• Jehle, P. M. (2003). Steroid-induced osteoporosis: how can it be avoided?. Nephrol Dial Transplant 18: 861-864 [Full Text]  
• Gordon, M-M, Stevenson, S, Hunter, J A, Gudbjornsson, B, Juliusson, U I, Gudjonsson, F V (2002). Steroids cause osteoporosis. Ann Rheum Dis 61: 947-948 [Full Text]  
• Paget, S (2002). Steroids cause osteoporosis. Ann Rheum Dis 61 : 1-2 [Full Text]