Endocrine Abstracts

Introduction: Systemic steroids have an established role in the management of numerous medical conditions across all specialities. Osteoporosis predisposing to osteoporotic fracture is a well known adverse effect of long term steroid treatment, which can affect at an early stage of the treatment. Established steroid induced osteoporosis is associated with significant co-morbidity and is difficult to reverse.

Aim: To determine the frequency of osteoporosis prophylaxis given to patients on long term steroid treatment in compliance with Royal college guidelines.

Methodology: Retrospective study of all patients (out patients and inpatients) who were on maintenance dose of steroids (≤7.5 mg) for more then 3 months during our study period. Data collection was completed by accessing pharmacy database, appointment letters and inpatient records.

Results: A total of 327 patients were included in this study, 90% were in age group of 50–89 years, 83% were from rheumatology, 8% care of the elderly, 7% respiratory medicine and 2.5% gastroenterology speciality. Out of these, only 19% of the patients were given bisphosphonates and calcium and vitamin D3 supplements as prophylaxis to prevent osteoporosis. About 29.5% were given only bisphosphonates, 9.5% were on calcium and vitamin D3 and others (60%) were not prescribed any form of prophylaxis against osteoporosis. Eight percent of patients were under 65 (39%) years of age underwent DEXA scan and 10% of patients over 65 years underwent DEXA scan. About 136/258 (53%) rheumatology patients, 17/26 (65%) elderly care patients, 18/22 (81%) respiratory patients and none out of the 8 gastroenterology patients complied with guidelines.

Conclusion: There is ever increasing evidence emphasising the importance of bisphosphonates in prevention of steroid induced osteoporosis. This study highlights the lack of uniformity in prescription of bone protectives to prevent osteoporosis and the necessity to educate the physicians. The hospital pharmacy can play an active role in identification of high-risk patient.