In article <001801bd7151$743ebc00$5ee7869f@jomag>, Joseph Gallagher
<[log in to unmask]> writes
>Is it accepted practice now that patients on long term steroids should have
>Didronel PMO or similar agents ? In other words in 1998 ,if you have
>patients on long term steroids and not on anti bone loss agents how would a
>group of your peers judge your care. Jez that last sentence gives me the
>creeps.
This is a tricky area isn't it? It's come up in some work I've been
doing for a project in the Dip Ther course at Imperial (plug: very good
course btw)
Can I quote from a BMJ editorial in 1993 entitled "Steroid Oseoporosis,
A pragmatic approach is needed while prospective trials are awaited"
It points aout that one of the problems in this tricky area is that most
trials that have been done about all the wizzo treatments for bones is
that they all seem to use Bone density as the measurement of success
rather than fracture rate, and while it seems likely there will be some
connection it isn't yet clear what that relationship is.
It ends with this paragraph,
"In clinical practice patients prescribed low doses of steroids for
under 12 months can be reassured. Those starting long term treatment
should be advised to have an adequate intake of calcium, to take
oestrogen replacemnts if they are women past the menopause, and on the
basis of published controlled studies consider preventative treatment
with vitamin D analogues or bisphosphanates to reduce vertebral bone
loss. Uncertainty will be removed only by prospective studies with
fractures as an end point"
Another editorial in the Brit Journal of Rheumatology 1997 confirms that
there is still no prospective data indicating a predictive value from
bone density measurements.
It also points out all our advice about exercise has no evidence to back
it up.
It's still a very tricky area, and the answer probably is that we should
be considering treatment more readily, (only 14% of patients on long
term steroids had had any prophylactic therapy in a study in Nottingham
in 1996.)
But what we actually do is still a bit debatable
--
Peter Marshall Phone +44 118 966 9222
Fax +44 118 935 3174
email [log in to unmask] Home +44 118 966 8794
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