Introduction BSG guidelines recommend that supplementation of calcium and vitamin D is given when systemic steroid use is necessary and that co-administration of bisphosphonates with steroids is given for patients aged over 65 years or with known osteoporosis/osteopenia.1 Data collected in the 3rd Round UK IBD audit were used to determine whether these guidelines were followed.
Methods Retrospective patient data from 198 sites of up to 40 patients per site were collected using an online form. Inclusion criteria were age >17 years at the date of admission with a discharge diagnosis of IBD from September 2010 to August 2011. A list of relevant ICD10 and OPCS codes was provided to aid patient identification. Data items collected in UC and CD included the number of patients discharged taking corticosteroids (CS) and bone protective agents. In CD only data were collected on CS and bone protective agent use in the outpatient setting. Statistical analysis used Fishers exact test to generate two-tailed p values.
Results Bone protective agents are underused. Bone protective agents were more likely to be used in UC patients discharged on steroids than in CD (UC: 66.2%, 1443/2181; CD: 58.7%, 1022/1742, p=0.021). Among 600 CD outpatients prescribed steroids for >3 months in the previous year 404 (67.3%) also received bone protection; this was not significantly different to inpatient care of CD patients (p=0.07). Of 600 outpatients who had received steroids for over 3 months in the last year 132 (22.2%) had a DEXA scan.
Conclusion Compliance with BSG guidelines regarding the use of bone protection for patients taking steroids is poor. Only 2/3 of IBD inpatients discharged on steroids were given bone protective agents. This figure is similar to patients treated in the outpatient setting. Approximately 1/5 CD patients who received a course of steroids in the outpatient setting also had a DEXA scan. Unfortunately further information was not available in order evaluate whether these patients were risk stratified for fragility fractures. It remains unclear why bone protection was significantly better prescribed in UC patients than CD. Further analysis of this data with logistic regression is needed in order to see whether other factors are influencing these results. Clinicians are further encouraged to prescribe bone protection for these patients. Bone protective measures must be promoted and hopefully the culture of prescribing can be changed for the better.
Competing interests None declared.
Reference 1. Mowat C, Cole A, Windsor A, et al. Guidelines for the management of inflammatory bowel disease in adults. Gut 2011. doi:10.1136/gut.2010.224154.