A Local Clinical Audit on Osteoporosis Prevention and Management in Sudanese Patients Treated with Long Term Oral Glucocorticoids for Rheumatic Diseases in a Military Tertiary Hospital in West Khartoum

Sara Elhadari,Hani Hussein,Alnor Alagib

doi:10.4236/ojim.2018.84020

Abstract

Background: Glucocorticoids (GC) are considered a mainstay as well as symptomatic and disease-modifying therapy for rheumatic diseases. They are generally used to quickly dampen inflammation, reduce duration of disease flares and as a maintenance therapy. Conventionally, oral GC are to be prescribed for short periods when possible; mainly, because of their side effects when used for long periods. One of the most important drawbacks of prolonged GC therapy is the risk of bone loss (osteoporosis (OP)) and osteoporotic fragility fracture (OFF). Objective: The aim of this audit was to assess counselling, prevention and management of OP in patients with rheumatic conditions who are or were receiving high doses of oral GC for three months or more against standard international guidelines. Method: The audit was carried out in March/April 2018 for a period of four weeks in a busy rheumatology service in Khartoum, Sudan. A Performa was used to collect data manually from eligible patients and their outpatient medical cards retrospectively. Then, data were audited against standard guidelines. Result: Overall, the selected Centre failed to meet the audit standard of 50% of eligible patients being appropriately managed for OP/OFF according to NICE and ACR guidelines. Conclusion: Huge areas of deficiency in the practice were identified. Acknowledging socioeconomic difficulties in the area of study, simple measures, such as carrying out a fracture risk assessment, optimizing calcium and vitamin D supplements with life style modification and patient education, would have a great impact on patients treated with steroids for rheumatic diseases.

Highlights

Prolonged use of oral Glucocorticoids (GC) is considered a major risk factor for osteoporosis (OP)) and osteoporotic fragility fracture (OFF); Corticosteroid induced osteoporosis (CIOP) is the commonest form of secondary OP with 12% of patients on long term GC experiencing a fracture [1]
The majority of non-eligible patients attending the clinic were on a daily maintenance dose of 5 mg of prednisolone with or without Disease modifying anti-rheumatic drugs (DMARDs) for their rheumatic conditions
There are few audits which looked at the risk of OP/OFF with long term oral GC administration in rheumatic diseases [8] [9] [10] and this is the first in Sudan

Summary

Introduction

Prolonged use of oral Glucocorticoids (GC) is considered a major risk factor for osteoporosis (OP)) and osteoporotic fragility fracture (OFF); Corticosteroid induced osteoporosis (CIOP) is the commonest form of secondary OP with 12% of patients on long term GC experiencing a fracture [1]. Steroid treated patients with rheumatic diseases are good candidates to investigate the overall approach of prevention and management of OP. Some rheumatic conditions such as rheumatoid arthritis (RA) are considered independent risk factors for OP especially in those with high disease activity [3] [4] [5]. Objective: The aim of this audit was to assess counselling, prevention and management of OP in patients with rheumatic conditions who are or were receiving high doses of oral GC for three months or more against standard international guidelines. Acknowledging socioeconomic difficulties in the area of study, simple measures, such as carrying out a fracture risk assessment, optimizing calcium and vitamin D supplements with life style modification and patient education, would have a great impact on patients treated with steroids for rheumatic diseases

Methods

Results

Conclusion