SAN FRANCISCO (MedscapeWire) Nov 14 Physicians need to do a better job prescribing antiresorptive drugs to prevent bone loss in women taking glucocorticoids for chronic diseases, according to research presented here Monday at the 65th annual meeting of the American College of Rheumatology.
"Physicians are not connecting the use of glucocorticoids with bone loss and that these patients are at high risk for fractures," said lead author J. Timothy Harrington, MD, a clinical associate professor of medicine at the University of Wisconsin in Madison. "Any patient started on corticosteroids should be started on bisphosphonates and any patient with low bone mass should be treated with bisphosphonates."
Harrington and colleagues conducted a review of how often women are prescribed concomittant antiresorptive therapy. They reviewed data from 408 patients receiving 5 mg or more daily of the glucocorticoid prednisone for at least 3 consecutive months.
In these patients, only 38% had received a bone mineral density test using dual x-ray absorptiometry. In addition, only 30% of the patients had been prescribed an antiresorptive drug, such as estrogen, a bisphosphonate, raloxifene, and calcitonin. In women older than 45 years taking the glucocorticoid, who are at even greater risk of suffering glucocorticoid-induced osteoporosis, 56% had received a bone mineral density test and 60% had been prescribed an antiresorptive medication.
Of these women, 34% received estrogen, 20% bisphosphonate, 4% calcitonin, and 2% raloxifene.
Harrington noted that although the majority of these women were receiving hormone replacement therapy, possibly for causes other than bone maintenance, current American College of Rheumatology guidelines recommend bisphosphonates, which offer superior bone protection compared with estrogen.
Harrington disclosed he has served as a consultant and/or speaker for the makers of two bisphosphonates, Aventis Pharmaceuticals (Actonel), and Merck (Fosamax).
"Women starting these drugs [glucocorticoids] may lose 10% of their bone mass within a year," he said. "Everyone starting glucocorticoids should be on one of these drugs to block that initial bone loss. We need to continue the educational efforts towards physicians."
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