A Canadian survey on the management of corticosteroid induced osteoporosis by rheumatologists.
OBJECTIVE
To survey the practice pattern of Canadian rheumatologists (CR) on their management of corticosteroid induced osteoporosis in their premenopausal (PrM) and postmenopausal (PoM) female patients.


METHODS
The practice pattern was surveyed using a 17 item questionnaire probing the diagnosis, prevention, treatment, and monitoring of osteoporosis in PrM and PoM women receiving longterm oral systemic corticosteroid therapy.


RESULTS
Most CR investigated and treated osteoporosis themselves, 13% referred to other specialists for investigation, and 22% referred for treatment. Eighty-two percent of CR used dual energy x-ray absorptiometry (DEXA) to confirm a diagnosis of osteoporosis. Most CR initiated investigation for osteoporosis at the start or within the first year of starting longterm systemic corticosteroid therapy: PrM 87% and PoM 93%. The most frequently used initial strategy for the prevention of osteoporosis was as follows. PrM: calcium and vitamin D3 (53%); PoM: hormone replacement therapy (HRT) and calcium (29%). The most common initial choice for treatment of established osteoporosis was as follows: PrM: etidronate (53%); PoM: bisphosphonates +/- HRT (53%). Ninety-six percent of CR used only bone mineral density (BMD) measurement to monitor therapy for corticosteroid induced osteoporosis. Most CR monitored BMD every 12 to 24 months for PrM (81%) and PoM (84%). The BMD parameter(s) (T and Z scores as measured by DEXA) used to initiate therapy for corticosteroid induced osteoporosis was variable.


CONCLUSIONS
It appears that, while certain trends are evident, there is still considerable variability in the management of corticosteroid induced osteoporosis.
Soucy
E
E
Department of Medicine, University of Western Ontario, London, Canada.
Bellamy
N
N
Adachi
J D
JD
Pope
J E
JE
Flynn
J
J
Sutton
E
E
Campbell
J
J
D015502:Absorptiometry, Photon / Q000706:statistics & numerical data; D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D019386:Alendronate / Q000627:therapeutic use; D015519:Bone Density; D002116:Calcitonin / Q000627:therapeutic use; D002170:Canada; D003625:Data Collection; D012968:Etidronic Acid / Q000627:therapeutic use; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000517:prevention & control; D017698:Postmenopause; D011216:Practice Management, Medical; D010818:Practice Patterns, Physicians'; D017697:Premenopause; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012219:Rheumatology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
D000305:Adrenal Cortex Hormones; D002116:Calcitonin; D012968:Etidronic Acid; D019386:Alendronate