More Awareness of Guidelines to Prevent Corticosteroid-Induced Osteoporosis Needed
Laszio Dosa, Medscape Medical News
Physicians should be more aware of the American College of Rheumatology (ACR) guidelines for the prevention of osteoporosis induced by corticosteroid drugs, according to a presentation by Antonio A. Lazzari, MD, PhD, at the 67th annual scientific meeting of American College of Rheumatology. 
Dr. Lazzari and colleagues, from the Department of Veterans Affairs, Boston Healthcare System, in Massachusetts, examined the outpatient files of 203,170 veterans.  They identified 16,143 veterans who had taken oral corticosteroids, usually prednisone, between 1998 and 2001.  They also identified 4,847 of these veterans who had taken prednisone chronically.  (These patients had received more than a three-month supply of the drug in a given year.)
The researchers found that vertebral and nonvertebral fractures were 30% higher in the chronic corticosteroid users compared with the nonusers (relative risk, 1.30; 95% confidence interval, 1.13- 1.50).
In only 36% of those cases, interventions to manage osteoporosis were taken, including bone mineral desity (BMD) measurements and prescription of calcium, vitamin D, or bisphosphonates as necessary. 
The ACR guidelines recommend the identification and treatment of corticosteroid-induced osteoporosis.  However, the study shows that, “a substantial proportion of our patient population receiving long-term corticosteroids (did) not received preventive intervention,” Dr. Lazzari and colleagues write. 
“The major importance of our work was to demonstrate that by performing an educational and teaching intervention we were able to improve compliance with the ACR guidelines in terms of prevention and treatment of osteoporosis,” Dr. Lazzari told Medscape. 
He added that it is important to make healthcare providers who prescribe orticosteroids aware of the importance of treating and managing osteoporosis.  “Initially we verified that a low number of patients were bieing treated according to the guidelines, “Dr. Lazzari said.  “(Then,) we initiated a program to give courses to providers within primary care and to subspecial(ists), including gastroenterolog(ists), hematologists nephrologists, and pulmonary care doctors (to educated them about the guidelines).  And by doing so were able to improve the compliance with the guidelines in terms of treatment and prevention of osteoporosis.” 
Dr. Lazzari advises physicians to be aware of the potential dangers of the medication, especially for patients who may receive prednisone or other corticosteroids, including prednisone, they should receive a bone density test initially and preventive medicines need to be implement, “ he told Medscape.  
In an interview with Medscape, Nancy Lane, MD associate professor of medicine in the Division of Rheumatology, University of California, San Francisco, agreed with Dr. Lazzari’s message. 
“The hardest part in any medical breakthrough is implementing it.” As Dr. Lazzari said, “giving physicians recommendations on how to prevent and treat with steroid-induced osteoporosis is great.”  Dr. Lane moderated the session at which Dr. Lazzari’s research was presented. 
“The only problem is you have to get them to implement the recommendations.  And he has done that by starting a clinic within primary care and directly contacting the primary care physicians, “Dr. Lane said.  “He has been able to improve the acceptance and usage of these recommendations, which make such a difference in preventing the morbidity associated with steroid-induced bone loss.  We are very excited about his work.”