A hospital-based study of prophylactic therapy in glucocorticoid-induced osteoporosis

To find out the proportion of patients who qualifies to receive prophylactic therapy for glucocorticoid-induced osteoporosis.

Retrospective record review. Participants Current users of oral glucocorticoids referred for bone mineral density estimation to assess their fracture risk (n=134).

Clinical history and bone mineral density of the spine and proximal femur.

Based on the current U.K. guidelines published by the College of Physicians of London in 2002, 22 of 57 (probability of 0.39) patients under 20 years, 19 of 38 (probability of 0.5) between 20-49 years, 22 of 28 (probability of 0.79) between 50-64 years and 10 of 11 (probability of 0.9) above 64 years, qualified for the diagnosis of glucocorticoid-induced osteoporosis and prophylactic therapy was indicated for them. The prevalence of glucocorticoid-induced osteoporosis was not different between men and women in any age group.

Due to the restricted availability of DXA scan facility, initiation of prophylactic therapy without baseline bone mineral density appears rational in current users of oral glucocorticoids older than 50 years as 80-90% of them would qualify for such therapy. However, only 40-50% of current glucocorticoids users younger than 50 years would require such therapy and simultaneous prescribing of prophylaxis appears unnecessary in 50-60% of them. Attempts should be made to estimate baseline bone mineral density in this group of patients.