Glucocorticoid-induced osteoporosis: unawareness or negligence in India?

The burden of osteoporosis is on the rise and glucocorticoids are one of the leading causes of drug-induced osteoporosis. According to available guidelines, patients on long-term glucocorticoid therapy should receive adequate prophylaxis to prevent osteoporosis.

To compare prescription patterns in relation to Royal College of Physicians (RCP) Guidelines 2002. To identify prescribing trends for prophylaxis and management of steroid-induced osteoporosis.

We conducted a retrospective audit for patients in a tertiary care center to determine whether clinicians are evaluating and appropriately following prophylactic guidelines for corticoid-induced osteoporosis. Information regarding risk assessment for osteoporosis, instructions regarding its prevention, bone mineral density measurements, and prophylactic therapy were recorded.

One hundred and five patients (38 men and 67 women), more then 18 years of age were included in this study. Of the 105 patients, 56% had at least one documented intervention for osteoporosis prevention (calcium, vitamin D, bisphosphonates or a bone mineral density study). Only three patients received bisphosphonates for osteoporosis prophylaxis.

The study shows poor pre-therapeutic risk assessment, absence of instructions regarding preventive measures, inappropriate investigation for presence of osteoporosis, and unacceptable absence of bone protective agents.