Profilaxis de la osteoporosis en pacientes tratados con dosis elevadas de glucocorticoide

Abstract

Background: chronic use of glucocorticoids (GCs) is the most common cause of secondary osteoporosis (OP). However, the prevention of GC-induced OP remains suboptimal despite its inclusion in OP management guidelines. Objective: to analyze the prophylaxis of GC-induced OP at high doses in clinical practice. Methods: the dispensation of GCs and concomitant treatment for OP was analyzed in a district with 2 health care areas. Patients older than 50 years who were dispensed ≥ 90 tablets of prednisone 30 mg through a pharmacy were included. The following data were collected from health records and the electronic pharmacy application: age, sex, reason for using GCs, number of prednisone containers dispensed, bone densitometry performed, and any concomitant use of bisphosphonates or denosumab. Results: a total of 427 patients were included (mean age 66 years M 51 % women). The most frequent body systems involved were respiratory (46 %), cutaneous (10 %), rheumatic (9 %) and neurologic (8 %). OP prophylaxis was dispensed in 59 cases (13.8 %). In the multivariate analysis, prophylaxis was associated with age > 70 years (OR, 4.23; 95 %CI, 2.11-8.49), female sex (OR, 3.15; 95 %CI, 1.47-6.74), having a rheumatic OR, neurologic disease (OR, 5.33; 95 %CI, 2.53-11.23), a bone densitometry assessment (OR, 3.55; 95 %CI, 1.66-7.57) and dispensation of > 120 prednisone tablets from the pharmacy (OR, 2.31; 95 %CI, 1.14-4.70). Conclusion: in our setting, GC-induced OP prophylaxis was definitely suboptimal. Training sessions are needed for doctors who prescribe high doses of GCs, and electronic prescription alerts should be implemented.