General practice

Use of oral corticosteroids in the community and the prevention of secondary osteoporosis: a cross sectional study

^a Division of Respiratory Medicine, City Hospital, Nottingham NG5 1PB, ^b Department of General Practice, Queen's Medical Centre, Nottingham

Correspondence to: Dr Walsh.

Abstract

Objective: To determine the prevalence of continuous use of oral steroids in the general population, the conditions for which they are prescribed, and the extent to which patients taking oral steroids are taking treatment to prevent osteoporosis.
Design: A cross sectional study with a four year retrospective review of drug treatment.
Setting: Eight large general practices in central and southern Nottinghamshire.
Subjects: A population of 65 786 patients (52% women) registered with a general practitioner during 1995.
Results: 303 patients (65% (197) women) aged 12-94 years were currently taking "continuous" (for at least three months) oral corticosteroid treatment. This figure represents 0.5% of the total population and 1.4% (245/17 114) of patients aged 55 years or more (1.7% (166/9601) of women). The usual steroid was prednisolone (97% (294/303)), the mean dose was 8.0 mg/day, and the median duration of oral steroid treatment determined in 149 patients was three years. The most common conditions for which continuous oral steroids were prescribed were rheumatoid arthritis (23% (70)), polymyalgia rheumatica (22% (66)), and asthma or chronic obstructive airways disease (19% (59)). Only 41 (14%) of the 303 patients taking oral steroids had received treatment for the prevention of osteoporosis over the past four years. Although 37 of the 41 patients were women, only 10% (18/181) of the women over 45 years taking continuous oral corticosteroids were currently taking hormone replacement therapy.
Conclusions: If our figures are typical then they suggest that over 250 000 people in the United Kingdom are taking continuous oral steroids and that most of these are taking no prophylaxis against osteoporosis.

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Danish data confirm low prevalence of HRT among women prescribed oral corticosteroids

Charlotte Olesen, Henrik Toft Sorensen, Flemming Hald Steffensen, Gunnar Lauge Nielsen, and Jorn Olsen
BMJ 1996 313: 1264. [Extract] [Full Text]

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• Goldstein, M. F., Fallon, J. J. Jr, Harning, R. (1999). Chronic Glucocorticoid Therapy-Induced Osteoporosis in Patients With Obstructive Lung Disease*. Chest 116: 1733-1749 [Abstract] [Full text]  
• Anderson, F., Cooper, C (1999). The influence of osteoporosis in trauma. Trauma 1: 181-192 [Abstract]  
• COMPSTON, J E (1999). Management of bone disease in patients on long term glucocorticoid therapy. Gut 44: 770-772 [Full text]  
• Lips, P. (1999). Prevention of corticosteroid induced osteoporosis. BMJ 318: 1366-1367 [Full text]  
• Walsh, L J, Wong, C A, Cooper, S, Guhan, A R, Pringle, M, Tattersfield, A E (1999). Morbidity from asthma in relation to regular treatment: a community based study. Thorax 54: 296-300 [Abstract] [Full text]  
• Geusens, P., Dequeker, J., Vanhoof, J., Stalmans, R., Boonen, S., Joly, J., Nijs, J., Raus, J. (1998). Cyclical etidronate increases bone density in the spine and hip of postmenopausal women receiving long term corticosteroid treatment. A double blind, randomised placebo controlled study. Ann Rheum Dis 57: 724-727 [Abstract] [Full text]  
• Saag, K. G., Emkey, R., Schnitzer, T. J., Brown, J. P., Hawkins, F., Goemaere, S., Thamsborg, G., Liberman, U. A., Delmas, P. D., Malice, M.-P., Czachur, M., Daifotis, A. G., Lane, N., Correa-Rotter, R., Yanover, M., Westhovens, R., Epstein, S., Adachi, J. D., Poubelle, P., Melo-Gomes, J., Rodriguez-Portales, J. A., The Glucocorticoid-Induced Osteoporosis Interventi, (1998). Alendronate for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. NEJM 339: 292-299 [Abstract] [Full text]  
• Roux, C., Oriente, P., Laan, R., Hughes, R. A., Ittner, J., Goemaere, S., Di Munno, O., Pouillès, J. M., Horlait, S., Cortet, B. (1998). Randomized Trial of Effect of Cyclical Etidronate in the Prevention of Corticosteroid-Induced Bone Loss. J. Clin. Endocrinol. Metab. 83: 1128-1133 [Abstract] [Full text]  
• Dick, A. D, Azim, M., Forrester, J. V (1997). Immunosuppressive therapy for chronic uveitis: optimising therapy with steroids and cyclosporin A. Br J Ophthalmol 81: 1107-1112 [Full text]  
• BIJLSMA, J. W J (1997). Prevention of glucocorticoid induced osteoporosis. Ann Rheum Dis 56: 507-509 [Full text]  
• Olesen, C., Sorensen, H. T., Steffensen, F. H., Nielsen, G. L., Olsen, J. (1996). Danish data confirm low prevalence of HRT among women prescribed oral corticosteroids. BMJ 313: 1264-1264 [Full text]  
• (1996). Corticosteroid-induced osteoporosis. DTB 34: 84-86 [Abstract] [Full text]  
• (1996). Few Steroid Users Get Osteoporosis Prophylaxis. JWatch Women's Health 1996: 13-13 [Full text]