RESUMEN
Guidelines for the prevention of glucocorticoid (GC) induced osteoporosis (GIOP) were implemented in a level 5 Irish Hospital with cross sectional audit of inpatient prescribing undertaken before and after. Prior to guideline implementation, elemental calcium (Ca) with Vitamin D (VitD) was prescribed for 11/66 (17%) of patients on GCs with 2/66 (3%) also receiving bisphosphonate (BP) therapy. Subsequent to guideline implementation, Ca with VitD was prescribed for 19/55 (35%) of patients on GCs with 11/55 (20%) also receiving BP therapy, representing a 2 and 6 fold respective increase. Internal promotion of guidelines is an effective strategy for healthcare improvement but needs refinement with or without repetition to achieve better patient outcomes.
Asunto(s)
Conservadores de la Densidad Ósea/uso terapéutico , Glucocorticoides/efectos adversos , Adhesión a Directriz/estadística & datos numéricos , Osteoporosis , Pautas de la Práctica en Medicina/estadística & datos numéricos , Densidad Ósea/efectos de los fármacos , Calcio de la Dieta/uso terapéutico , Auditoría Clínica , Estudios Transversales , Difosfonatos/uso terapéutico , Glucocorticoides/administración & dosificación , Humanos , Irlanda , Osteoporosis/inducido químicamente , Osteoporosis/prevención & control , Guías de Práctica Clínica como Asunto , Prevención Secundaria/métodos , Vitamina D/uso terapéuticoRESUMEN
BACKGROUND: Osteogenesis imperfecta (OI) is a heritable disorder of variable phenotype that is characterised by bone fragility and frequent fractures, with deformities and short stature in more severe cases. AIMS: We sought to review the response to treatment in a cohort of adult patients with OI. METHODS: Charts of 16 patients with OI attending a metabolic bone disease clinic were reviewed, particularly with respect to the response to treatment using bisphosphonates and recombinant human parathyroid hormone (rhPTH). The response to treatment was assessed by monitoring bone mineral density (BMD) and bone turnover markers (BTMs). RESULTS: In response to bisphosphonate therapy, median (range) BMD increased at the spine by 15.1(6.9-43.7) %. In response to rhPTH in 2 cases, spinal BMD increased by 40.3 and 27.2 %. CONCLUSION: OI is debilitating disorder, but the course of the disease may be altered by treatment that increases BMD such as bisphosphonates and rhPTH. Both serial BMD and BTM aid in assessing response to intervention. Further study is needed with regard to fracture prevention.