Osteoporosis prevention in myasthenia gravis: a reminder

Acta Neurologica Scandinavica
S J Lewis, P E Smith

Abstract

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.

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Citations

Mar 9, 2004·Clinical Neurology and Neurosurgery·Nobuo WakataAtushi Nakazato
Nov 30, 2011·FASEB Journal : Official Publication of the Federation of American Societies for Experimental Biology·Antonios O AliprantisTed S Gross
Jun 18, 2014·Osteoporosis International : a Journal Established As Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA·S KesikburunA K Tan
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Jul 8, 2011·Acta Neurologica Scandinavica. Supplementum·M T KampmanT Holmøy
May 1, 2013·Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research·Douglas J DiGirolamoKaryn A Esser
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Aug 30, 2017·Autoimmunity·Minako OshimaM Zouhair Atassi
Jan 12, 2021·Frontiers in Psychology·Ryan R KellyAmanda C LaRue

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