long term steroids (>5mg/d, doesn't say for how long) reduces bmd by
15-25% (quote from bandolier conference 1997, url below)
http://www.jr2.ox.ac.uk/bandolier/bandopubs/bandocon3full.html
http://www.jr2.ox.ac.uk/bandolier/band37/b37-4.html
the NNT for calcium and vit D (elderly female popn) is about 20 over
3 years, the second url, and it probably is cost effective. In the
high risk patient would we be justified in thinking that it would be
likely to be even more cost-effective? By comparison the
biphosphanates are expensive, (beware the wrath of the PCG overlord)
can cause oesophagitis, and i can't find anything to suggest they are
cost effective.
In the patient on long term steroids the DEXA scan shouldn't change
management, and so shouldn't be necessary.
Forgetting the scan, is it right to combine calcium with vit D
analogues (is it safe)? (remembering we would need to monitor calcium
levels and renal function as well).
So, the 28yr old male patient with a chronic inflammatory lung
condition on steroids, i haven't put him on anything yet. should i?
owen dempsey
General Practitioner
Huddersfield,
work:01484-654504
home: 01484-654794
e-mail: [log in to unmask]
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