Is enough attention being given to the adverse effects of corticosteroid therapy?

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.