0
Editor's Correspondence |

Osteoporosis and Fracture Risk Prevention in Long-term Glucocorticoid Therapy—Reply

Vasi Naganathan, FRACP; Philip Sambrook, FRACP
Arch Intern Med. 2001;161(14):1781. doi:.
Text Size: A A A
Published online

Extract

In reply

We read with interest the results and conclusions based on the chart review of patients receiving long-term steroid treatment by Drs Edin and Arsad Karcic. In our cohort of 229 long-term corticosteroid users,1 only 18% (41/229) were receiving some form of osteoporosis prevention (hormone replacement, bisphosphonate, or vitamin D analogue). Only 4% (3/72) of the men were receiving osteoporosis prevention, compared with 24% (38/157) of the women. On further analysis, we found that, apart from sex, none of the other variables, such as age, current steroid use, duration of steroid use, bone density, or presence of vertebral deformity, was predictive of whether treatment for osteoporosis prevention had been initiated. The ad hoc basis on which treatment for osteoporosis prevention was initiated in our study group is in contrast to the clear recommendation outlined in recent guidelines. A guideline directed at patients using 7.5 mg/d or more of prednisone (equivalent) that was developed in the United Kingdom recommends treatment for patients who have one or more of the following criteria: presence of osteoporotic fractures, age older than 65 years (irrespective of sex), strong risk factors for osteoporosis, and low bone density.2 The results of our study also provide an insight into what might be happening in everyday clinical practice. In a survey of Australian rheumatologists, more than 80% said they would initiate treatment (hormone replacement, bisphosphonate, or vitamin D analogue) to prevent osteoporosis in postmenopausal women who are starting corticosteroid therapy.3 In practice, however, this figure seems to be much lower.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 1

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles
Jobs
JAMAevidence.com

Users' Guides to the Medical Literature
Osteoporosis

Users' Guides to the Medical Literature
A trial of sodium fluoride as secondary prevention against osteoporosis in postmenopausal women...

brightcove.createExperiences();