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Am Fam Physician. 2000;61(3):798

Osteoporosis is one of the most frequent and long-lasting side effects of long-term corticosteroid therapy. Recent studies have found this side effect to be preventable if appropriate steps are taken. The American College of Rheumatology's recent guidelines recommend a baseline measurement of bone density before initiation of chronic corticosteroid therapy, as well as follow-up measurements to assess bone loss. The treatment guidelines include 1,500 mg of calcium per day, vitamin D supplementation at a dosage of 400 to 800 IU per day, hormone replacement therapy in postmenopausal women without contraindications and further treatment if these steps do not prevent bone loss. Buckley and associates studied the frequency of bone density assessments and interventions to prevent bone loss in patients with long-term use of corticosteroids.

Adult ambulatory patients within a health care system who had been taking at least 5 mg of prednisone per day (or the equivalent dosage of another corticosteroid) for at least three months were enrolled in the study. Telephone surveys were performed to ask for details of the patients' corticosteroid use, their knowledge of side effects associated with corticosteroid use, their knowledge of medications intended to prevent bone loss, their current use of these preventive medications and their history of bone density testing.

Of the 147 patients who met the criteria for this study, only 20 percent listed osteoporosis as a potential side effect of corticosteroid use. Fewer than 30 percent had undergone a bone density measurement at the time of the interview. Forty-six percent of patients knew that calcium could be used to prevent bone loss, but only 12 percent knew that vitamin D supplementation was also effective. The majority of the patients were not receiving one or more of the treatments recommended for the prevention of osteoporosis.

The authors conclude that these patients had a low level of understanding about the risk of osteoporosis in long-term corticosteroid therapy. They also found that bone density measurements were greatly underutilized in this group. The majority of patients receiving long-term corticosteroid therapy are not receiving the recommended treatments to help prevent osteoporosis. The authors encourage physicians to understand that osteoporosis is a preventable side effect of corticosteroid therapy.

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