A national survey to assess investigation and management protocols followed in dealing with steroid-induced osteoporosis

Abstract

We assessed investigations and management protocols for patients starting long-term steroid therapy. Rheumatology, respiratory, hematology, oncology, and gastroenterology consultants were asked five questions designed to assess investigation and management protocols followed in dealing with 50-year-old male, 25- and 75-year-old female patients. The response rates were as follows: rheumatologists 11/14 (78.6%), gastroenterologists 19/31 (61.3%), respiratory physicians 13/26 (50%), hematologists 10/25 (40%), oncologists 6/21 (28.6%). In 50-year-old men, calcium + vitamin D was recommended by 6/11 (54.54%) rheumatologists, 7/13 (53.84%) respiratory physicians, 5/10 (50%) hematologists, 2/6 (33.33%) oncologists, and 13/19 (68.42%) gastroenterologists. Bisphosphonates were recommended by 3/11 (27.22%) rheumatologists, 8/13 (61.53%) respiratory physicians, 2/10 (20%) hematologists, and 5/19 (26.31%) gastroenterologists. Bone densitometry was considered by 4/11 (36.36%) rheumatologist, 3/13 (23.07%) respiratory physicians, 2/10 (20%) hematologists, 8/19 (42.10%) gastroenterologists. Calcium, phosphate, and alkaline phosphate were checked by 3/11 (27.27%) rheumatologists, 3/13 (23.07%) respiratory physicians, 2/10 (20%) hematologists, 3/6 (50%) oncologists, 6/19 (31.57%) gastroenterologists. In 25-year-old women, 4/11 (36.37%) rheumatologists, 3/13 (23.07%) respiratory physicians, 2/10 (20%) hematologists, 1/6 (16.66%) oncologists, and 4/19 (21.05%) gastroenterologists considered bone densitometry. Calcium, phosphate, and alkaline phosphatase were checked by 3/11 (27.27%) rheumatologists, 1/13 (07.69%) respiratory physicians, 3/10 (30%) hematologists, 3/6 (50%) oncologists, and 6/19 (31.57%) gastroenterologists. Calcium + vitamin D treatment was favored by 8/11 (72.72%) rheumatologists, 8/13 (61.51%) respiratory physicians, 5/10 (50%) hematologists, 2/6 (33.33%) oncologists, 14/19 (73.68%) gastroenterologists. Bisphosphonates were considered by 2/18 (18.18%) rheumatologists, 6/13 (46.15%) respiratory physicians, 1/10 (10%) hematologists, 1/6 (16.66%) oncologists, and 3/19 (15.78%) gastroenterologists. In 70-year-old women, calcium + vitamin D was recommended by 8/11 (72.72%) rheumatologists, 9/13 (69.23%) respiratory physicians, 5/10 (50%) hematologists, 2/6 (33.33%) oncologists, and 15/19 (78.94%) gastroenterologists. Bisphosphonates were considered by 9/11 (81.81%) rheumatologists, 13/13 (100%) respiratory physicians, 9/10 (90%) hematologists, 2/6 (33.33%) oncologists, and 18/19 (94.73%) gastroenterologists. Reloxifene was considered by 4/11 (36.36%) rheumatologists and 2/6(33.33%) oncologists. This survey demonstrates the lack of consensus in investigating and treating male and young female patients at risk, exceptions being elderly women.