Osteoporosis prophylaxis during corticosteroid treatment: failure to prescribe.

AIMS To investigate prescribing patterns to prevent steroid induced osteoporosis. To compare prophylactic prescribing with National Osteoporosis Society (NOS) guidelines. METHOD All patients (n=92) taking oral corticosteroids admitted to general medical wards at a district general hospital were prospectively investigated over a nine month period. RESULTS Variations from recommended management were revealed. Altogether 64.7% of all inpatients who qualified for prophylaxis for steroid induced osteoporosis were not provided with any suitable agent. It was also found that 21.6% of those who qualified for treatment received a bisphosphonate, the only treatment currently licensed for preventing steroid induced osteoporosis. Of those prescribed prophylactic treatment, a bisphosphonate was selected for 39.3%, hormone replacement therapy was given to 25.0%, and 35.7% received treatment that is not recommended in NOS guidelines. CONCLUSION This study revealed substantial variations from NOS guidelines. It is suggested that osteoporosis prophylaxis during steroid treatment is promoted by local hospital guidelines, hospital and community pharmacists, audit, and general practitioners.