Prevention of osteoporosis in glucocorticoid-treated neurology patients.
OBJECTIVE
Iatrogenic, including corticosteroid-induced osteoporosis is preventable with administration of osteoprotective biphosphonates. The best medical practice is published in the National Guidelines: UK Osteoporosis Consensus Group (1998, update 2002). We conducted an audit in prednisolone-treated general neurology patients, to assess compliance to national guidelines, raise awareness of osteoporosis prevention, and improve clinical practice in a tertiary neurology referral centre.


RESULTS
Preintervention: Of the 48 cases (21 male) identified twenty-nine (61%) received osteoporosis prophylaxis. Nineteen (40%) were given biphosphonates, while 10 (21%) hormone replacement therapy or calcium and Vitamin D.


METHODS
Results were presented to the consultant body. Postintervention: Data were collected prospectively on 48 patients (30 male) in year 2001. Thirty-eight (79%) received prophylaxis: 35 (73%) were started on biphosphonates, while 3 (6%) on calcium and Vitamin D. This process was repeated 2 years later to assess sustainability. Of the 48 patients, 44 (92%) received prophylaxis: 41 (86%) were taking biphosphonates, while 3 (6%) calcium and Vitamin D.


CONCLUSIONS
We present an original and complete audit on osteoporosis prophylaxis in a typical population of neurology patients. Though initial results were similar to previous reports, our audit led to significant improvement in clinical practice. National guidelines could not be followed meticulously, as our centre has no regular access to bone densitometry. Our patient population had other risk factors for osteoporosis apart from steroid use. Therefore, we recommend that neurologists in this setting use osteoporosis prophylaxis for all their patients on long-term corticosteroids.
Lozsadi
D A
DA
Walton Centre for Neurology and Neurosurgery, University of Liverpool, Lower Lane, Fazakerley, Liverpool L9 7LJ, UK. lozsadi@doctors.org.uk
Peters
G
G
Sadik
H Y
HY
Kellett
M W
MW
Fox
S H
SH
Smith
D F
DF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage; D002118:Calcium / Q000008:administration & dosage; D015914:Estrogen Replacement Therapy; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009422:Nervous System Diseases / Q000188:drug therapy*; D010024:Osteoporosis / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011859:Radiography
D050071:Bone Density Conservation Agents; D005938:Glucocorticoids; D002118:Calcium