Background: Although the corticosteroids are valuable anti-inflammatory and
immunosuppressive agents, they also possess many potential adverse effects
, especially with continued use. In particular, long-term corticosteroid ex
posure carries a significant risk of osteoporosis.
Aim: To review the use of corticosteroids in patients presenting to the maj
or teaching hospital in Tasmania, Australia; principally to determine wheth
er patients receiving long-term corticosteroid therapy were being monitored
for loss of bone mineral density and offered preventive therapy for osteop
orosis.
Methods: A retrospective review of the medical records for 212 consecutive
patients admitted to the medical wards of the hospital over a 5-month perio
d and receiving treatment with either oral or inhaled corticosteroids, was
performed. An extensive range of demographic and clinical variables was rec
orded for each patient. Patients were also questioned about diet and exerci
se, and whether they had undergone tests for measuring bone mineral density
or blood glucose.
Results: The median age of the patients was 69 years (range: 15-90 years) a
nd 58% were female. Over half (53%) of the patients were on oral corticoste
roids only, with 26% using inhaled corticosteroids only, and 21% on both or
al and inhaled corticosteroid therapy. The most common conditions for which
patients were receiving corticosteroid therapy were asthma (37% of patient
s), chronic obstructive pulmonary disease (33%) and rheumatoid arthritis (1
7%). The most commonly used oral corticosteroid was prednisolone (93%), the
median daily dose was 10 mg prednisolone equivalent, and the median durati
on of oral corticosteroid treatment was 50 weeks. Disregarding short course
s, the median duration of oral corticosteroid treatment was 104 weeks. Almo
st one-third (31%) of the patients receiving oral corticosteroid treatment
had been taking the equivalent of 7.5 mg prednisolone daily for at least 6
months. Only 11% of all patients on oral corticosteroids and 21% of those w
ho had been taking oral corticosteroids for at least one year had documente
d evidence of bone mineral density testing being performed in the past in t
he hospital. Only 21% of all patients on oral corticosteroids and 31% of th
ose who had been taking oral corticosteroids for at least one year were rec
eiving medication for osteoporosis prevention, and only 15% of women over 4
5 years of age and on oral corticosteroid therapy were taking hormone repla
cement therapy. Only about half of the patients on long-term systemic corti
costeroid therapy had either documented evidence in their hospital medical
records, or were aware, of having undergone blood glucose testing in the pr
eceding 12 months.
Conclusions: More attention to the prevention and monitoring of possible ad
verse effects of long-term corticosteroid therapy is warranted. Guidelines
covering preventive measures and treatment options for corticosteroid-induc
ed osteoporosis need to be considered routinely when using these agents.