Lewis S J, Smith P E
Department of Neurology, University Hospital of Wales, Cardiff, UK.
Acta Neurol Scand. 2001 May;103(5):320-2. doi: 10.1034/j.1600-0404.2001.103005320.x.
Consensus guidelines for bone management of patients taking corticosteroids suggest two main interventions: Dual energy X-ray absorptiometry (DEXA) scanning in those taking prednisolone > or =7.5 mg daily for > or =6 months (repeated every 1-3 years as indicated). Bisphosphonate therapy for those taking prednisolone > or =15 mg daily for > or =6 months regardless of DEXA result, and also for patients with known or high risk of developing osteoporosis (including those aged >65 years).
We audited adherence to these guidelines in all adults with myasthenia gravis (MG) attending our neurology service.
Of 80 patients with MG (47 male, mean age 63.3 years), 34 (43%) had received corticosteroids for > or =6 months. Eighteen were taking prednisolone > or =7.5 mg daily (mean dose 16.6 mg) yet only 4 of these (22%) had undergone DEXA scanning. Of the 13 patients meeting the guideline criteria to receive bisphosphonate therapy, this was prescribed to only 7 (54%). Two others were prescribed vitamin D, 2 a calcium supplement and 2 were receiving no prophylaxis.
In these MG patients the guidelines were followed in only a minority. Neurologists need greater awareness of the bone health consequences of prescribing long-term corticosteroids.
关于服用皮质类固醇患者骨管理的共识指南提出了两项主要干预措施：对于每日服用泼尼松龙≥7.5毫克且持续≥6个月的患者进行双能X线吸收测定法（DEXA）扫描（根据指示每1 - 3年重复一次）。对于每日服用泼尼松龙≥15毫克且持续≥6个月的患者，无论DEXA结果如何，以及对于已知患有骨质疏松症或有骨质疏松症高风险的患者（包括年龄>65岁的患者），给予双膦酸盐治疗。
我们审核了在我们神经科就诊的所有成年重症肌无力（MG）患者对这些指南的遵循情况。
在80例MG患者（47例男性，平均年龄63.3岁）中，34例（43%）接受皮质类固醇治疗≥6个月。18例患者每日服用泼尼松龙≥7.5毫克（平均剂量16.6毫克），但其中只有4例（22%）进行了DEXA扫描。在符合指南标准应接受双膦酸盐治疗的13例患者中，仅7例（54%）接受了该治疗。另外2例患者服用了维生素D，2例服用了钙补充剂，2例未接受任何预防措施。
在这些MG患者中，只有少数患者遵循了指南。神经科医生需要更加了解长期开具皮质类固醇药物对骨骼健康的影响。
