Men's Osteoporosis Support GroupOsteoporosis prophylaxis in patients receiving chronic glucocorticoid therapy Ann Saudi Med. 2009 May-Jun;29(3):215-8. Osteoporosis prophylaxis in patients receiving chronic glucocorticoid therapy. Sadat-Ali M and others, PMID: 19448373. Glucocorticoid-induced osteoporosis (GIOP ) is the most common form of secondary osteoporosis. This Saudi Arabian study retrospectively looked at the prescription records of individuals who were prescribed >/=7.5 milligrams of prednisolone for 6 months or longer during a 6-month period. Records were checked for a history of dual-energy X-ray absorptiometry (DXA) and use of oral calcium, vitamin D and anti-resorptives (such as one of the bisphosphonates such as Fosamax or Actonel) was noted. Of a total of 165 individuals (100 males and 65 females) who underwent long-term glucocorticoid therapy (approximately 40 months), only a total of 26 had DXA performed. Of these, roughly 50% of both males and females were osteoporotic and 52.4% of the females and 40% of the males were osteopenic. Calcium and vitamin D were prescribed to most patients, but none were prescribed an approved osteoporosis medication. The authors concluded, "Patients in this study were neither investigated properly nor treated according to the minimum recommendations for the management of GIOP." Editor's comments. The problems with GIOP inducing osteoporosis have been noted many times on this site, including in the October 2001 Newsletter that outlined the recommendations of the American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis. Note that, "The committee recommends obtaining a baseline measurement of bone mineral density (BMD) at the lumbar spine and/or hip when initiating long-term (i.e., >6 months) glucocorticoid therapy." Yet eight years after this recommendation, only 3% of males undergoing long-term GIOP had pre-treatment DXA. The committee also recommends for, "Patients beginning therapy with a prednisone equivalent of >5 mg/day for > 3 months. These patients should receive bisphosphonates (use with caution in premenopausal women.)" This study was not done in the United States, but I have an Update that discusses a 2006 study that was done here that showed, “Bone mineral density testing was performed or ordered for less than half of the glucocorticoid-treated patients and less than one third were taking bisphosphonate therapy.” Note that most patients received calcium and vitamin D supplementation, but that was ineffective for osteoporosis prevention, as would be expected. An FDA-approved osteoporosis therapy is needed to prevent GIOP. So individuals who are about to undergo long-term glucocorticoid use must request proper diagnostic testing and therapy, to include a pre-treatment DXA and and FDA-approved osteoporosis medication to prevent lose of bone mineral density from the GIOP. Don't assume your physician will do that, ask for it.
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