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BMJ. 1996 August 10; 313(7053): 344–346.
PMCID: PMC2351752

Use of oral corticosteroids in the community and the prevention of secondary osteoporosis: a cross sectional study.


OBJECTIVE--To determine the prevalence of continuous use of oral steroids in the general population, the conditions for which they are prescribed, and the extent to which patients taking oral steroids are taking treatment to prevent osteoporosis. DESIGN--A cross sectional study with a four year retrospective review of drug treatment. SETTING--Eight large general practices in central and southern Nottinghamshire. SUBJECTS--A population of 65,786 patients (52% women) registered with a general practitioner during 1995. RESULTS--303 patients (65% (197) women) aged 12-94 years were currently taking "continuous" (for at least three months) oral corticosteroid treatment. This figure represents 0.5% of the total population and 1.4% (245/17 114) of patients aged 55 years or more (1.7% (166/9601) of women). The usual steroid was prednisolone (97% (294/303)), the mean dose was 8.0 mg/day, and the median duration of oral steroid treatment determined in 149 patients was three years. The most common conditions for which continuous oral steroids were prescribed were rheumatoid arthritis (23% (70)), polymyalgia rheumatica (22% (66)), and asthma or chronic obstructive airways disease (19% (59)). Only 41 (14%) of the 303 patients taking oral steroids had received treatment for the prevention of osteoporosis over the past four years. Although 37 of the 41 patients were women, only 10% (18/181) of the women over 45 years taking continuous oral corticosteroids were currently taking hormone replacement therapy. CONCLUSIONS--If our figures are typical then they suggest that over 250,000 people in the United Kingdom are taking continuous oral steroids and that most of these are taking no prophylaxis against osteoporosis.

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  • Khosla S, Lufkin EG, Hodgson SF, Fitzpatrick LA, Melton LJ., 3rd Epidemiology and clinical features of osteoporosis in young individuals. Bone. 1994 Sep-Oct;15(5):551–555. [PubMed]
  • Rice P, Simmons K, Carr R, Banatvala J. Near fatal chickenpox during prednisolone treatment. BMJ. 1994 Oct 22;309(6961):1069–1070. [PMC free article] [PubMed]
  • Cooper C, Coupland C, Mitchell M. Rheumatoid arthritis, corticosteroid therapy and hip fracture. Ann Rheum Dis. 1995 Jan;54(1):49–52. [PMC free article] [PubMed]
  • Verstraeten A, Dequeker J. Vertebral and peripheral bone mineral content and fracture incidence in postmenopausal patients with rheumatoid arthritis: effect of low dose corticosteroids. Ann Rheum Dis. 1986 Oct;45(10):852–857. [PMC free article] [PubMed]
  • Adinoff AD, Hollister JR. Steroid-induced fractures and bone loss in patients with asthma. N Engl J Med. 1983 Aug 4;309(5):265–268. [PubMed]
  • Isaacs AJ, Britton AR, McPherson K. Utilisation of hormone replacement therapy by women doctors. BMJ. 1995 Nov 25;311(7017):1399–1401. [PMC free article] [PubMed]
  • Luengo M, Picado C, Del Rio L, Guañabens N, Montserrat JM, Setoain J. Vertebral fractures in steroid dependent asthma and involutional osteoporosis: a comparative study. Thorax. 1991 Nov;46(11):803–806. [PMC free article] [PubMed]
  • Reid IR, King AR, Alexander CJ, Ibbertson HK. Prevention of steroid-induced osteoporosis with (3-amino-1-hydroxypropylidene)-1,1-bisphosphonate (APD). Lancet. 1988 Jan 23;1(8578):143–146. [PubMed]
  • Pak CY, Eun HM, McArthur RG, Yoon JW. Association of cytomegalovirus infection with autoimmune type 1 diabetes. Lancet. 1988 Jul 2;2(8601):1–4. [PubMed]
  • Adachi J, Cranney A, Goldsmith CH, Bensen WG, Bianchi F, Cividino A, Craig GL, Kaminska E, Sebaldt RJ, Papaioannou A, et al. Intermittent cyclic therapy with etidronate in the prevention of corticosteroid induced bone loss. J Rheumatol. 1994 Oct;21(10):1922–1926. [PubMed]
  • Mulder H, Struys A. Intermittent cyclical etidronate in the prevention of corticosteroid-induced bone loss. Br J Rheumatol. 1994 Apr;33(4):348–350. [PubMed]
  • Diamond T, McGuigan L, Barbagallo S, Bryant C. Cyclical etidronate plus ergocalciferol prevents glucocorticoid-induced bone loss in postmenopausal women. Am J Med. 1995 May;98(5):459–463. [PubMed]
  • Luengo M, Picado C, Del Rio L, Guañabens N, Montserrat JM, Setoain J. Treatment of steroid-induced osteopenia with calcitonin in corticosteroid-dependent asthma. A one-year follow-up study. Am Rev Respir Dis. 1990 Jul;142(1):104–107. [PubMed]
  • Luengo M, Pons F, Martinez de Osaba MJ, Picado C. Prevention of further bone mass loss by nasal calcitonin in patients on long term glucocorticoid therapy for asthma: a two year follow up study. Thorax. 1994 Nov;49(11):1099–1102. [PMC free article] [PubMed]
  • Lukert BP, Johnson BE, Robinson RG. Estrogen and progesterone replacement therapy reduces glucocorticoid-induced bone loss. J Bone Miner Res. 1992 Sep;7(9):1063–1069. [PubMed]
  • Sambrook P, Birmingham J, Kelly P, Kempler S, Nguyen T, Pocock N, Eisman J. Prevention of corticosteroid osteoporosis. A comparison of calcium, calcitriol, and calcitonin. N Engl J Med. 1993 Jun 17;328(24):1747–1752. [PubMed]
  • Lukert BP, Raisz LG. Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Intern Med. 1990 Mar 1;112(5):352–364. [PubMed]
  • Eastell R. Management of corticosteroid-induced osteoporosis. UK Consensus Group Meeting on Osteoporosis. J Intern Med. 1995 May;237(5):439–447. [PubMed]
  • Reid IR. Pathogenesis and treatment of steroid osteoporosis. Clin Endocrinol (Oxf) 1989 Jan;30(1):83–103. [PubMed]
  • Lukert BP. Glucocorticoid-induced bone loss: a neglected problem. Chest. 1994 Jun;105(6):1640–1641. [PubMed]
  • Spector TD, Sambrook PN. Steroid osteoporosis. BMJ. 1993 Aug 28;307(6903):519–520. [PMC free article] [PubMed]
  • Sheldon TA, Raffle A, Watt I. Department of Health shoots itself in the hip. Why the report of the Advisory Group on Osteoporosis undermines evidence based purchasing. BMJ. 1996 Feb 3;312(7026):296–297. [PMC free article] [PubMed]

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