Long-term corticosteroids: Act early to minimise fracture risk

An Australian review into a lack of monitoring of the long-term effects of corticosteroids, which are commonly prescribed as anti-inflammatory and immunosuppressant medication, has fuelled a renewed call for clinicians, pharmacists and patients to work together and take preventative steps to minimise risk of bone loss and fracture, particularly in older people.

The findings, published yesterday in the Journal of Pharmacy Practice and Research (JPPR), the flagship research publication of the Society of Hospital Pharmacists of Australia (SHPA), advises risk monitoring, vitamin D and calcium supplements and fracture prevention therapy should be considered when oral corticosteroids are used for longer than one month.

Corticosteroids are commonly prescribed to mitigate chronic inflammatory or autoimmune disorders, including rheumatoid arthritis and chronic obstructive pulmonary disease (COPD), among others.

First author Dr Kerrie Westaway from the School of Pharmacy and Medical Sciences at the University of South Australia says identifying risks and balancing them with the benefits of treatment is crucial when considering long-term oral corticosteroid therapy.

‘Corticosteroids can provide welcome relief, but when taken orally for prolonged periods at prednisolone-equivalent doses greater than 5mg per day, they are associated with a high incidence of bone loss and muscle atrophy and weakness.’

Dr Westaway says Australian Department of Veterans’ Affairs health data shows many older people are not receiving a bone mineral density test or medicines for osteoporosis prevention when receiving long-term oral corticosteroids.

‘To minimise risk of bone fracture, at-risk patients should be promptly identified and preventive measures, including calcium and vitamin D supplements and fracture prevention therapy, should be considered.’

Professor Michael Dooley, President of SHPA says the expertise of pharmacists to improve quality use of medicines is increasingly important as the proportion of older Australians increases.

‘While the side effects of long-term oral corticosteroid use are well documented, today’s recommendations are a timely reminder of the importance of all clinicians, including pharmacists, working in multidisciplinary teams to partner with patients and minimise adverse effects of medicines.

‘The lowest effective dose taken for the shortest possible time, accompanied with evidence-based measures to reduce harm, exemplifies quality medicines management that must be delivered for all patients.’

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Media coverage
'Tackle cortiocsteroid-related bone loss and fracture: SHPA', AJP, Tuesday 18, April 2017.