Introduction Asthmatics dependant on oral corticosteroids are at risk of bone loss and significant increase in fracture risk at the hip and spine. Current guidelines recommend assessment of bone mineral density and the need for bone protection in any patient exposed to glucocorticoids for over three months. We sought to assess the usage of bone protection in steroid dependant asthmatics.
Method A retrospective analysis of patients admitted for a systematic assessment of asthma over a 12 month period at the Royal Brompton hospital was performed. Steroid dependence was defined as daily maintenance oral glucocorticoid for over three months. Other Inflammatory conditions requiring corticosteroids resulted in study exclusion.
Results 151 patients were admitted for a systematic assessment over a 12 month period. The mean age of subjects at assessment was 46 years of age (± 27 SD) and the majority were female (77%). Fifty four subjects (36%) were steroid dependent at the time of admission. The average daily dose of prednisolone prescribed was 12.5 mg (±5.9 SD). Two thirds of steroid dependent patients had been on corticosteroids for over 12 months (36/54).
At the time of referral 11 patients were on Bisphosphonates and 34 on vitamin D replacement. The systematic assessment encompassed a DEXA scan in 49 of the steroid dependent subjects; half demonstrated normal bone density (26/54), one third had osteopenia (16/54) and seven subjects had osteoporosis. Forty Six subjects had vitamin D levels checked and the mean levels were 48 nmol/L (±27 SD).
Bisphosphonates were stopped in seven patients with normal bone mineral density (13%), continued in 3 subjects and started during assessment in 4. Vitamin D supplementation was continued in 30 subjects, stopped in 2 and started in 5 subjects with osteopenia and low vitamin D levels.
Conclusions In a cohort of oral glucocorticoids steroid dependant asthmatics over half have normal bone mineral density. While calcium and vitamin D supplementation occurs in the majority of subjects bisphosphonate are often used unnecessarily in a predominantly pre-menopausal and female population. Clearer guidelines for the investigation and monitoring of bone protection in steroid dependent asthmatics are required.
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