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We congratulate Hart and Green for flagging up a worrying concern—failure to provide appropriate osteoporosis prophylaxis during planned long term corticosteroid treatment.1 We would like to complement their views by sharing the results of a similar study undertaken in our district general hospital between May and July 2001.
On analysing case notes and prescription records of 308 consecutive medical inpatients, 60 patients (mean age 68.7 years, range 37–89 years; 62% females) on long term steroid treatment were identified who would have qualified for osteoporosis prophylaxis. Of these only 26 patients (43%) were on effective prophylactic treatment (24 on bisphosphonates, two on hormone replacement therapy). Structured interview of these 60 patients revealed that 73% were not advised on appropriate lifestyle changes (namely cessation of smoking, avoidance of alcohol consumption, weight bearing exercises if appropriate, adequate dietary calcium intake, and measures to avoid falls). Thirty five per cent of the patients were unaware of the side effects of long term steroid consumption, including the risk of osteoporosis.
Thus, apart from failing to appropriately screen and provide osteoporosis prophylaxis to patients on long term steroids, we are also inadequately educating patients on lifestyle measures and the risks associated with long term steroid usage as per guidelines.2 Hospital physicians and general practitioners should make proactive attempts to improve this substandard practice. At least for hospital inpatients, we should not miss the opportunity to identify those on long term steroids and ensure that they are appropriately advised and commenced on osteoporosis prophylaxis.
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