Endocrine Abstracts

Background: Oral corticosteroids are a known risk factor for developing osteoporosis and subsequent fracture at higher bone mineral density than post menopausal osteoporosis. Bone loss is thought to be most pronounced in the first 12 weeks of steroid use, and existing guidelines recommend a fracture risk assessment and appropriate osteoporosis prophylaxis with calcium and vitamin D supplements and bisphosphonates. There is also a recognized role for FRAX scoring to help stratify osteoporotic fracture risk in these patients.

Methods: Fifty medical inpatients prescribed oral corticosteroids had their 10-year fracture risk calculated using the fracture risk assessment tool (FRAX). The management of these patients was then compared to the current recommendations.

Results: Twenty patients were categorized as low risk, 17 as intermediate risk and 13 as high risk for fragility fractures. Of those patients at low risk, 55% (n=11) had appropriate management, this fell to 12% (n=2) in the intermediate group and 15% (n=2) in the high risk group. Of the remaining patients, 16 low and intermediate risk patients were receiving treatment unnecessarily or before adequate investigation, seven intermediate risk patients were under-investigated and untreated, and 11 high risk patients were not on adequate treatment.

Conclusions: The risk assessment and management of adult patients taking oral corticosteroids is important to minimize the risk of fragility fractures. Patients are currently not being adequately investigated and treated for osteoporosis. We recommend that patients prescribed oral corticosteroids receive a fracture risk assessment on discharge and are managed appropriately in the community.