Use of bisphosphonates and dual-energy X-ray absorptiometry scans in the prevention and treatment of glucocorticoid-induced osteoporosis in rheumatology

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