Use of corticosteroids and bone-active medications in clinical practice ane ZOCHLING1, Peter NASH2, John RIORDAN3, Philip N. SAMBROOK4

Zochling, Jane, Nash, Peter, Riordan, John and Sambrook, Philip N. (2006) Use of corticosteroids and bone-active medications in clinical practice ane ZOCHLING1, Peter NASH2, John RIORDAN3, Philip N. SAMBROOK4. APLAR Journal of Rheumatology, 9 1: 37-42. doi:10.1111/j.1479-8077.2006.00162.x


Author Zochling, Jane
Nash, Peter
Riordan, John
Sambrook, Philip N.
Title Use of corticosteroids and bone-active medications in clinical practice ane ZOCHLING1, Peter NASH2, John RIORDAN3, Philip N. SAMBROOK4
Journal name APLAR Journal of Rheumatology   Check publisher's open access policy
ISSN 0219-0494
1756-1841
1756-185X
Publication date 2006-04
Sub-type Article (original research)
DOI 10.1111/j.1479-8077.2006.00162.x
Volume 9
Issue 1
Start page 37
End page 42
Total pages 6
Editor C. S. Lau
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell
Collection year 2006
Subject C1
321028 Rheumatology and Arthritis
730114 Skeletal system and disorders (incl. arthritis)
Formatted abstract
Aim: To assess the quality of care of patients beginning corticosteroid therapy with respect to bone protection.

Methods: Practicing rheumatologists in Australia were approached countrywide to recruit patients beginning corticosteroid therapy under their care. Use of bone-active medications in the ensuing year was recorded prospectively. Baseline and follow-up bone mineral density and fracture data were collected.

Results:
 Ninety-two patients (64% female) were enrolled by 18 rheumatologists. Seven patients reported a medical history of osteoporosis and 14 had already sustained a low-trauma fracture. The median corticosteroid dose at commencement of therapy was 20 mg of prednisone. Bone-active medications were commenced in 47% of patients within 3 months of commencing steroid therapy. These included calcium supplements (33%), vitamin D supplements (21%), hormone replacement therapy (11%), selective estrogen receptor antagonists (5%) and bisphosphonates (15%). Calcium and vitamin D supplementation usually accompanied bisphosphonate therapy. Median change in bone mineral density at the lumbar spine was −0.20 SD units over 12 months (range: −1.16–0.70, P = 0.007), and at the hip −0.10 SD units over 12 months (range −1.66–0.93, P = 0.24). There were 21 new fractures in 13 patients over the study period, with a vertebral fracture incidence of 0.16 per patient year. Of those patients taking bisphosphonate therapy, two had incident low-trauma fractures but there was no significant change in bone mineral density at the hip or spine.

Conclusions: Rheumatologists in Australia appear informed about the need for bone-active medications in patients who are commencing steroid therapy. However there remains room for improved awareness, as is seen by the low use of bisphosphonates.
Keyword Bone mineral density
Clinical practice
Glucocorticoid-induced osteoporosis
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2007 Higher Education Research Data Collection
School of Medicine Publications
 
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Created: Wed, 15 Aug 2007, 10:43:33 EST