United Kingdom. The National Osteoporosis Society has published guidelines for health care professionals on the prevention and management of corticosteroid-induced osteoporosis and an information sheet for patients. It is estimated that there are over 200,000 people in the United Kingdom taking oral corticosteroids who are at high risk of fractures because they are not given information on how to protect their bones from osteoporosis.
A survey of eight general practices showed that 87% of patients taking long-term or high- dose corticosteroids had not been given treatment to reduce bone loss, although 40% of patients taking corticosteroids suffer fractures due to fragile bones.
The guidelines include an algorithm for preventing and managing corticosteroid-induced osteoporosis, which can be applied to adult patients taking an oral daily dose of 7.5 mg or more of prednisolone (or equivalent dose of another corticosteroid) for six months or more. The guidelines advise that calcium and vitamin D supplementation should be recommended to patients if their normal diet is deficient and to high-risk patients such as house-bound or elderly patients. Patients on hormone replacement therapy should be encouraged to continue their treatment.
Treatment options include use of biphosphonates (calcitriol is an alternative for patients unable to tolerate biphosphonates or for younger patients in whom safety is a concern), HRT for post-menopausal women and testosterone for hypogonadal men.
The guidelines, entitled “Guidance on the prevention and management of corticosteroid induced osteoporosis” and the information sheet for patients can be obtained from the National Osteoporosis Society, P.O. Box 10, Radstock, Bath BA3 3YB, UK (tel. +44 (0)1761 471.771).
[See also the US National Osteoporosis Foundation Website at: http://www.nof.org/index. html]
Reference: The Pharmaceutical Journal Vol. 261, p.696, 31 October 1998.