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Prevention of glucocorticoid induced osteoporosis
  1. Department of Rheumatology and Clinical Immunology, University Hospital Utrecht, Box 85500, 3508 GA Utrecht, the Netherlands

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Most physicians are well aware that osteoporosis is one of the major complications of glucocorticoid treatment. Only a limited number of physicians, however, simultaneously prescribe medication to prevent the occurrence of glucocorticoid induced osteoporosis. Daily practice (in Europe) was recently evaluated in the area of Nottinghamshire in the United Kingdom.1 A community survey was carried out to determine the prevalence of continuous use of oral corticosteroids and simultaneous treatment to prevent osteoporosis. This survey covered a population of over 65 000 inhabitants; 303 patients, representing 0.5% of the population, had been taking oral corticosteroids for at least three months. The mean dose was 8 mg prednisolone daily, the medium duration of treatment was three years. In the course of four years only 41 of these 303 patients (14%) had received medication to prevent osteoporosis. In a large teaching hospital in the UK calcium supplementation was prescribed for only 6% of the patients treated with corticosteroids.2 These data clearly illustrate that measures to prevent glucocorticoid induced osteoporosis are not common in daily practice.

In clear contrast with this daily practice are the recent recommendations published by the American College of Rheumatology Task Force on Osteoporosis Guidelines.3 These guidelines are quite clear. For patients starting long term glucocorticoid treatment, bone mineral density (BMD) measurements should be performed. The BMD of a patient may be expressed as a T score (the difference in standard deviation (SD) with respect to the peak bone mass in a young adult of the same race and sex) or a Z score (the difference in SD with respect to that found for healthy age matched controls of the same race and sex). Patients with a BMD 1 SD or more below the peak bone mass (that is, T score <−1) are considered to have a low …

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