Managing corticosteroid induced osteoporosis in medical outpatients

As a preliminary step to developing a protocol for the management of corticosteroid induced osteoporosis we examined the case notes of patients attending medical clinics and studied the first 100 consecutive patients estimated to have taken 1 gram or more of prednisolone, or equivalent, in the previous six months. The patients who satisfied the inclusion criteria represented 2% of all medical outpatients. Inflammatory arthritis and obstructive airways disease together accounted for 50% of cases. The average daily dose of corticosteroids was highest in the respiratory patients (12 mg) and lowest in the rheumatology patients (7.5 mg). The question of osteoporosis had been considered in 47% of cases: of these, 27 (57%) were diagnosed as having osteoporosis by bone mineral density measurement or x-ray appearances, and 93% of the latter patients were receiving treatment for osteoporosis. The results indicate that while most physicians were aware of the problem of corticosteroid induced osteoporosis and treated most patients when diagnosed, more than 50% of patients on significant doses of corticosteroids were not investigated. We have therefore devised a management protocol and implemented it within the medical directorate.