treatment/prophylaxis of corticosteroid induced osteoporosis in adults - General Practice notebook.How to prevent steroid induced osteoporosis
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Prednisolone osteoporosis prophylaxis
Alternatively, physicians in this study may have failed to provide prophylaxis for several reasons. Firstly, they may have failed to predict a prolonged steroid course. Secondly, they may have failed to prescribe prophylaxis in anticipation when long term steroids were started. This may have occurred because physicians may have been unfamiliar with local guidelines or current literature or there may have been discontinuity of patient follow up and hence failure to intervene with prophylaxis when patients were reviewed or admitted while taking long term steroids.
Finally, NOS guidelines had been published but had not been specifically publicised in this hospital and although local guidelines had been produced, they had not been widely circulated. Only one patient with a bone densitometry scan indicating osteoporosis had not been given prophylaxis but this scan result had only just become available.
For our patients, appropriate prophylaxis was given to We suggest this may be promoted best by local hospital guidelines, hospital and community pharmacists, audit, and medical education. Skip to main content. Log in via OpenAthens. Log in using your username and password For personal accounts OR managers of institutional accounts. Forgot your log in details? Register a new account? Forgot your user name or password? Search for this keyword.
Advanced search. Log in via Institution. You are here Home Archive Volume 78, Issue Osteoporosis prophylaxis during corticosteroid treatment: failure to prescribe. Email alerts. Article Text. Article menu. Original article. Osteoporosis prophylaxis during corticosteroid treatment: failure to prescribe. Abstract Aims: To investigate prescribing patterns to prevent steroid induced osteoporosis. Statistics from Altmetric.
The distribution of conditions treated with steroids is shown in table 1. View this table: View inline View popup. Table 1 Distribution of conditions treated with steroids. Intermittent etidronate therapy to prevent corticosteroid-induced osteoporosis. N Engl J Med ; : —7. Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis. N Engl J Med ; : —9. Corticosteroid effects on proximal femur bone loss.
J Bone Miner Res ; 5 : — A UK consensus group on management of glucocorticoid-induced osteoporosis: an update. J Intern Med ; : — National Osteoporosis Society. Guidance on the prevention and management of corticosteroid-induced osteoporosis. London: NOS, Use of oral corticosteroids in the community: a cross sectional study.
BMJ ; : —6. Prevention of steroid induced osteoporosis. A missed opportunity? J Rheum Dis ; 54 : 66 —8. Get help. GPnotebook no longer supports Internet Explorer. To ensure the site functions as intended, please upgrade your browser. Microsoft is encouraging users to upgrade to its more modern Edge browser for improved security and functionality. This site is intended for healthcare professionals. Sign in.
❿Prednisolone osteoporosis prophylaxis -
Let op: de gel kan uw haar, uw wenkbrauwen, metaal (brillen en sieraden), kleding en beddengoed bleken. Het beste kunt u het medicijn 's avonds opsmeren.
De gel bleekt gekleurde kleding en stoffen, dus daar kunt u aan denken bij het aanbrengen (bijvoorbeeld met het beddengoed). Gebruik de gel ook NIET vlak voor, tijdens of vlak na het zonnebaden (in de zon of onder de zonnebank of een UV-lamp).
❾-50%}Prednisolone osteoporosis prophylaxis. How to prevent steroid induced osteoporosis
Bisphosphonates can decrease the risk of fractures in osteoporotic bone caused by oral corticosteroids. These include lack of adherence to National Osteoporosis Society NOS guidelines, lack of patient compliance, adverse drug reactions, or failure to anticipate the length of treatment at the beginning of a corticosteroid course.
It is during the first year of treatment that bone loss is most rapid. A short questionnaire was completed after interviewing each inpatient and inspecting their hospital notes. Current dosage, total previous steroid exposure, and the longest single continuous course of steroids were established. Other common risk factors for osteoporosis were noted: family history, being post-menopausal, alcohol consumption exceeding 30 units per week, and smoking for more than 10 years.
Patients were judged to qualify for prophylaxis against steroid induced osteoporosis if they were taking prednisolone continuously for more than six months and fulfilled the criteria specified in the guidelines. Effective prophylaxis for steroid induced osteoporosis was defined as a bisphosphonate or, in specific circumstances, hormone replacement therapy HRT.
The notes were inspected to discover whether osteoporosis had been confirmed on a densitometry scan or osteopenia had been judged to be shown on an x ray film. The underlying reason for treatment with steroids was recorded. Ninety two inpatients were identified between 1 January and 1 September ; there were 56 women and 36 men. The mean age was Fifty one patients qualified for primary prophylaxis according to the NOS guidelines. Eleven patients were taking bisphosphonates and seven HRT. Ten patients receiving long term steroids were taking inadequate osteoporosis prophylaxis: three were taking vitamin D plus calcium, two were taking vitamin D without calcium , and five were taking only calcium supplements.
Three patients had previously been taking a bisphosphonate which had been stopped due to poor compliance or intolerance and were not taking any alternative treatment. Of the 51 patients who qualified for prophylaxis, the mean total exposure was 34 mg of prednisolone.
The average duration of continuous exposure to steroids was 7. Four of these patients had received a continuous course for less than six months, although a course exceeding six months had been planned for each of them. Six patients who did not qualify had been prescribed prophylaxis and three of these were taking a bisphosphonate.
Eight patients had bone densitometry scans confirming osteoporosis and seven of these were receiving prophylaxis. Of these eight patients, only two would have qualified for prophylaxis according to their steroid exposure alone. Radiographs are a poor indicator of osteoporosis but 10 other patients had been judged osteopenic by this method and eight of these were taking prophylaxis. Our results demonstrated that many hospital patients For this study, effective prophylaxis included bisphosphonates or HRT.
Other medications including vitamin D plus calcium, calcium alone, vitamin D alone, and calcitonin have been appraised prospectively but found only to prevent bone loss in the lumbar spine and not to reduce fracture rate. Bisphosphonates are the drugs of choice for prophylaxis during steroid administration and HRT has been recommended in special circumstances.
Three patients were taking vitamin D plus calcium; this is recommended for osteoporotic patients whose diet is likely to be deficient or for high risk groups but not specifically recommended for steroid induced osteoporosis. There may be a number of reasons why patients did not take the prophylactic treatment of choice, cyclical bisphosphonates. Firstly, the NOS guidelines recommend that patients continue to take HRT if they subsequently start long term corticosteroids; this applied to seven patients.
A second reason is that bisphosphonates are sometimes unsuitable for elderly patients who may lack the understanding to comply with the complicated regimen. Another reason is that the more elderly patients may have considered prophylactic treatment unnecessary at their great age—the average age of our patients was 72 years. Alternatively, physicians in this study may have failed to provide prophylaxis for several reasons.
Firstly, they may have failed to predict a prolonged steroid course. Secondly, they may have failed to prescribe prophylaxis in anticipation when long term steroids were started. This may have occurred because physicians may have been unfamiliar with local guidelines or current literature or there may have been discontinuity of patient follow up and hence failure to intervene with prophylaxis when patients were reviewed or admitted while taking long term steroids.
Finally, NOS guidelines had been published but had not been specifically publicised in this hospital and although local guidelines had been produced, they had not been widely circulated. Only one patient with a bone densitometry scan indicating osteoporosis had not been given prophylaxis but this scan result had only just become available.
For our patients, appropriate prophylaxis was given to We suggest this may be promoted best by local hospital guidelines, hospital and community pharmacists, audit, and medical education. Skip to main content. Log in via OpenAthens. Log in using your username and password For personal accounts OR managers of institutional accounts. Forgot your log in details? Sign in. Sign in Register. This supplementation however is generally regarded as an adjunct therapy with an oral bisphosphonate represents the main form of therapy.
Bisphosphonates should not be given to women of child bearing capacity unless specialist advice has been sought. Bisphosphonates are incorporated into the skeleton and the potential effects on future pregnancies are unknown. In the event of intolerance or contraindication to bisphosphonate therapy, specialist advice should also be sought SIGN suggest with respect to options for bisphosphonate theray 5 : alendronic acid may be considered to prevent vertebral fractures in men and women on prednisolone doses of 7.
Aims: To investigate prescribing patterns to prevent steroid induced osteoporosis. Results: Variations from recommended management were revealed. Altogether It was also found that Of those prescribed prophylactic treatment, a bisphosphonate was selected for Conclusion: This study revealed substantial variations from NOS guidelines.
It is suggested that osteoporosis prophylaxis during steroid treatment is promoted by local hospital guidelines, hospital and community pharmacists, audit, and general practitioners. You will be able to get a quick price and instant permission to reuse the content in many different ways. Bisphosphonates can decrease the risk of fractures in osteoporotic bone caused by oral corticosteroids.
These include lack of adherence to National Osteoporosis Society NOS guidelines, lack of patient compliance, adverse drug reactions, or failure to anticipate the length of treatment at the beginning of a corticosteroid course. It is during the first year of treatment that bone loss is most rapid.
A short questionnaire was completed after interviewing each inpatient and inspecting their hospital notes. Current dosage, total previous steroid exposure, and the longest single continuous course of steroids were established. Other common risk factors for osteoporosis were noted: family history, being post-menopausal, alcohol consumption exceeding 30 units per week, and smoking for more than 10 years. Patients were judged to qualify for prophylaxis against steroid induced osteoporosis if they were taking prednisolone continuously for more than six months and fulfilled the criteria specified in the guidelines.
Effective prophylaxis for steroid induced osteoporosis was defined as a bisphosphonate or, in specific circumstances, hormone replacement therapy HRT. The notes were inspected to discover whether osteoporosis had been confirmed on a densitometry scan or osteopenia had been judged to be shown on an x ray film. The underlying reason for treatment with steroids was recorded.
Ninety two inpatients were identified between 1 January and 1 September ; there were 56 women and 36 men. The mean age was Fifty one patients qualified for primary prophylaxis according to the NOS guidelines. Eleven patients were taking bisphosphonates and seven HRT.
Ten patients receiving long term steroids were taking inadequate osteoporosis prophylaxis: three were taking vitamin D plus calcium, two were taking vitamin D without calciumand five were taking only calcium supplements. Three patients had previously been taking a bisphosphonate which had been stopped due to poor compliance or intolerance and were not taking any alternative treatment.
Of the 51 patients who qualified for prophylaxis, the mean total exposure was 34 mg of prednisolone. The average duration of continuous exposure to steroids was 7. Four of these patients had received a continuous course for less than six months, although a course exceeding six months had been planned for each of them.
Six patients who did not qualify had been prescribed prophylaxis and three of these were taking a bisphosphonate. Eight patients had bone densitometry scans confirming osteoporosis and seven of these were receiving prophylaxis. Of these eight patients, only two would have qualified for prophylaxis according to their steroid exposure alone. Radiographs are a poor indicator of osteoporosis but 10 other patients had been judged osteopenic by this method and eight of these were taking prophylaxis.
Our results demonstrated that many hospital patients For this study, effective prophylaxis included bisphosphonates or HRT. Other medications including vitamin D plus calcium, calcium alone, vitamin D alone, and calcitonin have been appraised prospectively but found only to prevent bone loss in the lumbar spine and not to reduce fracture rate. Bisphosphonates are the drugs of choice for prophylaxis during steroid administration and HRT has been recommended in special circumstances.
Three patients were taking vitamin D plus calcium; this is recommended for osteoporotic patients whose diet is likely to be deficient or for high risk groups but not specifically recommended for steroid induced osteoporosis. There may be a number of reasons why patients did not take the prophylactic treatment of choice, cyclical bisphosphonates. Firstly, the NOS guidelines recommend that patients continue to take HRT if they subsequently start long term corticosteroids; this applied to seven patients.
A second reason is that bisphosphonates are sometimes unsuitable for elderly patients who may lack the understanding to comply with the complicated regimen. Another reason is that the more elderly patients may have considered prophylactic treatment unnecessary at their great age—the average age of our patients was 72 years.
Alternatively, physicians in this study may have failed to provide prophylaxis for several reasons. Firstly, they may have failed to predict a prolonged steroid course. Secondly, they may have failed to prescribe prophylaxis in anticipation when long term steroids were started. This may have occurred because physicians may have been unfamiliar with local guidelines or current literature or there may have been discontinuity of patient follow up and hence failure to intervene with prophylaxis when patients were reviewed or admitted while taking long term steroids.
Finally, NOS guidelines had been published but had not been specifically publicised in this hospital and although local guidelines had been produced, they had not been widely circulated. Only one patient with a bone densitometry scan indicating osteoporosis had not been given prophylaxis but this scan result had only just become available. For our patients, appropriate prophylaxis was given to We suggest this may be promoted best by local hospital guidelines, hospital and community pharmacists, audit, and medical education.
Skip to main content. Log in via OpenAthens. Log in using your username and password For personal accounts OR managers of institutional accounts. Forgot your log in details? Register a new account? Forgot your user name or password? Search for this keyword. Advanced search. Log in via Institution. You are here Home Archive Volume 78, Issue Osteoporosis prophylaxis during corticosteroid treatment: failure to prescribe. Email alerts. Article Text. Article menu. Original article. Osteoporosis prophylaxis during corticosteroid treatment: failure to prescribe.
Abstract Aims: To investigate prescribing patterns to prevent steroid induced osteoporosis. Statistics from Altmetric. The distribution of conditions treated with steroids is shown in table 1.
View this table: View inline View popup. Table 1 Distribution of conditions treated with steroids. Intermittent etidronate therapy to prevent corticosteroid-induced osteoporosis. N Engl J Med ; : —7. Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis. N Engl J Med ; : —9. Corticosteroid effects on proximal femur bone loss. J Bone Miner Res ; 5 : — A UK consensus group on management of glucocorticoid-induced osteoporosis: an update. J Intern Med ; : — National Osteoporosis Society.
Guidance on the prevention and management of corticosteroid-induced osteoporosis. London: NOS, Use of oral corticosteroids in the community: a cross sectional study.
BMJ ; : —6. Prevention of steroid induced osteoporosis. A missed opportunity? J Rheum Dis ; 54 : 66 —8. Stevenson JC. Management of corticosteroid-induced osteoporosis. Lancet ; : —9. Read the full text or download the PDF:.
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Effective prophylaxis for steroid induced osteoporosis was defined as a bisphosphonate or, in specific circumstances, hormone replacement therapy (HRT). The. Bisphosphonates are very effective for the primary and secondary prevention of corticosteroid osteoporosis. Double blind studies have been performed with. Effective prophylaxis for steroid induced osteoporosis was defined as a bisphosphonate or, in specific circumstances, hormone replacement therapy (HRT). The. the prevention of osteoporotic fragility fractures. Background corticosteroids, untreated premature menopause or previous fragility fracture). Adults ; Prednisolone 1 mg/kg for 4 days then tapered (70 kg), mg ; Dexamethasone 2 cycles of 40 mg daily for 4 days, mg ; Prednisolone 4. N Engl J Med ; : —7. Stevenson JC. Forgot your log in details? Log in using your username and password For personal accounts OR managers of institutional accounts. Use of oral corticosteroids in the community: a cross sectional study. Of the 51 patients who qualified for prophylaxis, the mean total exposure was 34 mg of prednisolone.Get help. GPnotebook no longer supports Internet Explorer. To ensure the site functions as intended, please upgrade your browser. Microsoft is encouraging users to upgrade to its more modern Edge browser for improved security and functionality.
This site is intended for healthcare professionals. Sign in. Sign in Register. This supplementation however is generally regarded as an adjunct therapy with an oral bisphosphonate represents the main form of therapy. Bisphosphonates should not be given to women of child bearing capacity unless specialist advice has been sought. Bisphosphonates are incorporated into the skeleton and the potential effects on future pregnancies are unknown. In the event of intolerance or contraindication to bisphosphonate therapy, specialist advice should also be sought SIGN suggest with respect to options for bisphosphonate theray 5 : alendronic acid may be considered to prevent vertebral fractures in men and women on prednisolone doses of 7.
The treatment should be considered in patients who are intolerant of oral bisphosphonates and those in whom adherence to oral therapy may be difficult Notes:. Clinical specialties cardiovascular medicine dermatology diabetes and endocrinology ear, nose and throat evidence-based medicine gastroenterology general information general practice.
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