تقييم الإلتزام بالدلائل الإرشادية لتدبير تخلخل العظام لدى مرضى سوريين خاضعين لمعالجة جهازية طويلة الأمد بالقشرانيات السكرية

Abstract EN

Background Long-term glucocorticoid (GC) therapy has been instrumental in decreasing morbidity and mortality in a variety of diseases.

One of the most serious side effects of chronic glucocorticoid (GC) therapy is secondary osteoporosis.

Recommendations stemmed from international guidelines concerning GC induced osteoporosis (GIOP) are currently inadequately implemented in underdeveloped health care systems.

Objective This study aimed at evaluating GC induced osteoporosis (GIOP) prevalence, and implementation of current guidelines in a cohort of Syrian patients undergoing long term systemic GC therapy.

Methods This cross-sectional study was conducted in Al Mouassat teaching hospital in Damascus.

Patients on GC for over three months were interviewed and their medical records were thoroughly reviewed.

Information comprised age, BMI (kg/m2), past medical history, underlying disease, smoking, dietary calcium intake, GC indication, past and current dose and duration of GC therapy.

Implementation of guidelines was assessed based on bone mineral density (BMD) testing prior to this study, and practice of prevention and treatment of GIOP.

BMD at lumbar spine (L2-L4) and femoral neck were prospectively measured using Dual energy X-ray Absorptiometry (DXA).

Results A total of 81 patients were evaluated (age 42.1 ± 14.2 years; mean body mass index (BMI) 25.93 ± 5.01 kg/m2; and 74.1% females).

Rheumatoid arthritis, Pemphigus Vulgaris, and Systemic Lupus Erythematous were the top indications for GC prescription.

Average duration of GC was 48.0 ± 14.2 months, and average daily dose was 18.0 ± 21.07 mg equivalent of prednisolone.

Only 33.3% of the patients underwent a previous BMD testing.

Bisphosphonate was prescribed for 35.8% of the patients.

Despite that 60% of the patients received calcium or vitamin D supplementation, only 2% had calcium intake of ≥ 1000 mg, and 37% received Vit D dose according to guidelines (≥ 800 IU).

Moreover, prevalence of osteopenia/osteoporosis was as high as 87.7% and 61.7% at lumbar spine and femoral neck, respectively.

osteoporosis/osteopenia was similarly prevalent in men and women; however it was higher in older patients [51-70]-year-old, patients with BMI <19 kg/m2, and inpatients when compared with outpatients (p<0.05).

Conclusions This study proves the high prevalence of osteoporosis/osteopenia in a cohort of Syrian patients on chronic systemic GC therapy, and reveals that GIOP is overlooked and undertreated.

Enforcement of current guidelines is expected to improve GIOP management.