Bisphosphonates and steroids

  • Any patient over 70yrs who will be on more than 7.5mg daily for over 3months should be on bisphosphonates
  • This age group don’t need DEXA
  • Any patient sustaining or who has previously sustained a fragility fracture should be treated as high risk and offered bisphosphonates
  • Under 70yrs:
  • Offer dexa
  • If T </= -1.5 use a bisphosphonate
  • If T -1.5 -0 offer lifestyle and diet advice & repeat scan in 1-3 years if they’re staying on that long
  • If T = 0 then they only need repeat dexa if high dose steroids continue long term
  • Estimation of steroid probability can be estimated using FRAX
  • FRAX assumes a dose of 2.5-7.5mg so may underestimate in those taking more

Lifestyle advice = adequacy of dietary calcium, vit d in diet, weight bearing exercises, avoid smoking.

Rate of bone loss is greatest in the first few months of treatment so don’t delay treatment for assessment in those who are going to be on for three months.