The value of lateral vertebral assessment in patients receiving glucocorticoids referred for dual x-ray absorptiometry (DXA)

Abstract

Glucocorticoids are widely used to treat a number of medical disorders. Prolonged steroid use can cause osteoporosis can lead to a significant increase in fracture risk of the hip and spine. Vertebral fractures can indicate higher risk of both subsequent vertebral and non-vertebral fractures. Lateral vertebral assessment (LVA) can highlight patients who have asymptomatic vertebral fractures.A retrospective audit of patients referred for DXA who have been taking oral glucocorticoids for >3 months. DXA was performed and included total hip, femoral neck, lumbar spine and LVA.657 patients on glucocorticoids for >3 months were reviewed. Overall, vertebral fractures were present in 19.3%. Mean age 59.8 (±18) yrs with 72.3% patients being female. Common reasons for being on glucocorticoids included rheumatoid arthritis (47.1%), COPD (25.1%), gastrointestinal disorder (14.7%), bone marrow and renal transplants (7.5%) and inflammatory disorders (5.6%). 44.7% of patients had osteoporosis with the spine being the most likely site to be affected (35.5%). 31.2% of these patients were on treatment on referral. Patients who had vertebral were older and had more severe osteoporosis (p<0.001). 7.3% of overall fractures occured in the osteopenic group.Vertebral fractures were present in almost 1/5 osteopenic patients. LVA identifed osteopenic patients who would be an increased risk of subsequent fracture. As substantial bone loss occurs in the first 6 months of glucocorticoid treatment, these high-risk patients should be prioritised for osteoporosis treatment. Disclosure of Interest: None declared