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Approach in glucocorticoid-induced osteoporosis prevention: The EGEO study preliminary data
2009
Approach in glucocorticoid-induced osteoporosis prevention: The EGEO study preliminary data S. Migliaccio, S. Martin, B. Muccifora, R. Pastore, A. Ragno, M. Rotondi, E. D'Erasmo, G. Minisola, P. Falaschi The EGEO Study Group by GISMO Lazio, Italy Umberto I Hospital, “Sapienza” University of Rome, Italy Regina Apostolorum Hospital, Albano Laziale, Italy Acquapendente Hospital, Viterbo, Italy FBF Hospital, Isola Tiberina, Rome, Italy Hospital of Velletri, Rome, Italy S. Camillo Hospital, Rome, Italy Sant'Andrea Hospital, “Sapienza” University of Rome, Italy Introduction: It is well known that postmenopausal women assuming chronic glucocorticoid (GC) therapy have a 20 fold increase of vertebral fracture risk as compared to postmenopausal women without GC therapy. GC-induced osteoporosis (GIO) is linked to GC daily assumption with maximum effect within first months of treatment and decreasing to basal levels as the therapy is discontinued. In Italy, primary prevention of GIO is suggested when GC therapy (prednisone >5 mg/day or equivalent) is taken for a period longer than 3 months. Aim and Methods: Lazio GISMO (Italian Group for Study and Diagnosis of Bone Metabolism Diseases) group organized the EGEO study (GC and Osteoporosis Epidemiology) to evaluate physician's approach in preventing GIO. The study started on July 2008 involving 19 osteoporosis centres located in the Lazio area. Patients taking long-term GC therapy for different pathologies were recruited and the following informations were collected: medical history and anthropometric data, GC therapy (primary disease, molecule, dosage, time of prescription, physician's specialty), GIO type of screening and therapeutical intervention (DEXA exam at the beginning of therapy, preventive therapy, last DEXA exam performed). Results: 675 patients were included in the study up to April 2009, with a prevalence of females (F=78.7%, M=21.3), mean age was 61.5 ±13 yrs with 43.3% of individuals >66 yrs old. Preliminary data showed that prednisone (50%) and methylprednisone (43.3%) were the most prescribed GC, and oral administration was the most frequently used (80.3%). The GC prescription was given by rheumatologists (61%), pneumologists (23.26%), dermatologists (5.6%) and gastroenterologists (4%). GC therapy lasted longer than 24 months in 46.4% of patients, with regular assumption in 78% of individuals. Only 282 patients out of 675 (41.8%) performed DEXA exam at the beginning of the GC treatment, mainly prescribed by gastroenterologists (59.3%) and rheumatologists (49.6%). Interestingly, 15% of GC users showed normal hip bone mineral density (BMD) while 50.43% of GC users showed osteoporosis and 34.47% had osteopenia. After 3– 6 months of GC treatment 56.5% of patients had osteoporosis. GIO prevention therapy was prescribed only to 31.8% of patients and, among these, 85% were either osteoporotic or osteopenic. Gastroenterologists (48%), rheumatologists (39%), pneumologists (22.4%), and dermatologists (8%) were the specialists who approached GIO with prevention therapy mainly prescribing risedronate (39%) or alendronate (36%). Conclusions: A previous study by Walsh [1] showed that only 14% of GC treated patients was supported by an antiresorptive therapy. Our preliminary data confirm these previous results with a slight higher trend of antiresorptive therapy prescription, therefore indicating the need to stimulate awareness of both patients and specialists, who prescribe GC therapy, to an appropriate and prompt GIO prevention. [1] Walsh LJ, Wong CA, Pringle M, Tattersfield AE. Use of oral corticosteroids in the community and the prevention of secondary osteoporosis: a cross sectional study. BMJ 1996Aug 10;313(7053):344–6. doi:10.1016/j.bone.2009.07.053 Assessment of risk of osteoporosis in a population of menopausal women by OsteoRisk in Brazil A.N. Bueno, J.L. Vaz, J.F. Marques Neto, J.A. Mendonca Rheumatology, Universidade do Rio De Janeiro–UNIRIO, Rio de Janeiro, Brazil Rheumatology and Internal Medicine, Universidade Estadual de Campinas, Brazil Rheumatology and Internal Medicine, Pontificia Universidade Catolica de Campinas, Campinas, Brazil Background: The OsteoRisk is a tool based on anthropometric variables such as weight and age of the individual and has been found in a sample important in the Latin America. Methods: In this prospective study, 137 women were stratified using the formula OsteoRisk [0.2×(weight−age)] in correlation with lumbar spine, neck and total femur T score, serum calcium, 24 h urinary calcium and the calcaneus ultrasound (US). The patients were classified like OsteoRisk of the low (>1), moderate (−2
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