Bisphosphonate use in dermatology patients receiving long-term oral corticosteroid therapy

In a small study from a referral center for dermatology, most patients receiving prolonged oral corticosteroids for chronic skin diseases were not receiving therapies to prevent osteoporosis that may be caused by the drug, according to an article in the January issue of Archives of Dermatology.

Oral glucocorticoids, or corticosteriods, are prescribed for a variety of chronic skin diseases, as well as other conditions, according to background information in the article. "Independent of the reason for their use, all patients receiving long-term glucocorticoid treatment have an increased risk of developing osteoporosis," a decrease in bone mass that can lead to fractures, the authors report. Research has demonstrated that medications known as bisphosphonates can boost bone mineral density (BMD) and help reduce the risk of osteoporosis. The American College of Rheumatology (ACR) and the U.S. Department of Veterans Affairs have guidelines recommending their use alongside specific doses of glucocorticoids, though no such guidelines exist for dermatologists, the authors write.

Rosemarie H. Liu, M.D., Eastern Virginia Medical School, Norfolk, and colleagues reviewed 35 patients with chronic skin diseases referred to the Hospital of the University of Pennsylvania after October 1995. Each was taking glucocorticoids for at least one month before they were referred. The researchers obtained information about the participants' prescriptions during their clinic visits, by reviewing medical records and sometimes by telephone.

Twenty-eight (80 percent) of the patients were not taking bisphosphonates at the time they were referred. "The low rate of bisphosphonate use prior to referral and prolonged time interval until initiation of prophylaxis are disappointing because bisphosphonates are agreed to be the most efficacious agents known to prevent glucocorticoid-induced osteoporosis (GIOP)," the authors report. "This may be due to variations in knowledge about GIOP among different physician specialties."

"Unless there is a specific contraindication, bisphosphonates should be prescribed concomitantly with the initiation of corticosteroid therapy in diseases for which long-term glucocorticoid use is anticipated as part of the standard of care," they conclude.

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