Background The Royal college of physicians (RCP) guidelines recommend that all patients placed on long term glucocorticoids (GCs) are at risk of osteoporosis, especially when the dose exceeds ≥10mg of Prednisolone or equivalent for >3months1. Patients with Giant cell arteritis (GCA) and Polymyalgia Rheumatica (PMR) are particularly at risk.
Objectives To assess our departmental compliance with the RCP guidelines for glucocorticoid induced osteoporosis (GIO) published in 2002. Following review of the International Osteoporosis Foundation and the European Calcified Tissue Society and American college of Rheumatology (ACR) guidelines for GIO, we also looked into use of FRAX tool for risk assessment.
Methods Retrospective data collection of 50 patients diagnosed with either GCA or PMR was selected at random since 2010. Documentation of smoking history, alcohol intake, height and weight, history of falls and started dose of GCs were also noted. Data regarding DXA results, other imaging e.g. spinal x-rays, biochemistry and the use of the FRAX assessment tool were obtained. The use of bisphosphonate, calcium/vitamin D supplementation and steroid sparing agents were also recorded.
Results The majority of the patients were postmenopausal (mean age 75.2years, Range: 59–92) females (68%) with a diagnosis of PMR (72%). Ninety percent were over the age of 65years. The modal starting dose was 60mg of prednisolone in GCA patients and 15mg in those with PMR. Nine patients (18%) were identified as having an additional risk factor for osteoporosis such as thyrotoxicosis or premature menopause. History of falls was documented in 22%. Fourteen percent had a prior history of fragility fracture, of those 2% were <65years of age. Steroid sparing agent (Methotrexate (18%) and azathioprine (10%)) was commenced in 28%. None of the patients had a baseline FRAX assessment. Calcium and vitamin D supplementation was prescribed in 90%, of which 78% had this checked prior to administration. Adherence for bone protection was documented in 44%.
Conclusions The documentation of risk factors and DXA requests was inconsistent for various age groups. Bone protection was commenced in the majority of patients; especially calcium and vitamin D were prescribed in almost all patients. Based on the RCP guidelines, International Osteoporosis Foundation and the European Calcified Tissue Society and ACR guidelines for GIO, local departmental guidelines have been designed to ensure appropriate investigations and bone protection is considered all these patients. There is a need for new national guidelines incorporating FRAX tool.
Glucocorticoid-induced osteoporosis: guidelines for prevention and treatment. Prepared by a working group in collaboration with The Royal College of Physicians, The Bone and Tooth Society of Great Britain, and The National Osteoporosis Society. London: RCP; 2002. www.rcplondon.ac.uk/pubs/books/glucocorticoid/index.asp.
Disclosure of Interest None declared