Many Americans are on oral steroids for years without getting therapy to minimize the extra fracture risk that accompanies the potent drugs, according to a new study.

Based on a decade’s worth of national surveys, researchers found more than 2.5 million adults in the U.S. take the drugs - a rate that trumps all existing estimates from other countries.

Oral steroids such as prednisone are often used to treat inflammatory diseases like arthritis or immune system disorders. But they have serious side effects, with bone loss being a major issue, said Robert Overman, a research coordinator at the Cleveland Clinic Foundation in Ohio, who worked on the study.

“The longer you use steroids and the greater the amount of steroids, the greater your risk of fracture,” he told Reuters Health. “It can really affect a patient’s quality of life.”

That’s problematic, because more than a quarter of people took the drugs for at least five years. Yet less than one in 10 were on bisphosphonates, which are recommended for most people on steroids to prevent bone thinning, or osteoporosis.

According to osteoporosis expert Dr. Ethel S. Siris, guidelines call for people to have a bone density test before they are put on steroids. That way, bisphosphonates can be prescribed if appropriate.

But the new findings, in the journal Arthritis Care & Research, suggest that for a lot of patients that’s not happening.

“They are simply not being evaluated, nor are they being treated,” said Siris, who directs the Toni Stabile Osteoporosis Center at Columbia University in New York and wasn’t part of the new research. “The leaders in the bone field are very distressed.”

NOT GETTING NEEDED TREATMENT

Overman’s results are based on interviews with more than 26,000 people over 20, done between 1999 and 2008 as part of the National Health and Nutrition Examination Survey. Because they rely on self-reported drug use in the past month, the numbers come with some uncertainty and are probably an underestimate, the researchers caution.

Overall, 1.2 percent of people reported using oral steroids, typically prednisone. Seniors led the pack, with 2.7 percent of women in their 70s and 3.5 percent among men in their 80s on the drugs.

Siris called steroid use “one of the most powerful risk factors” for osteoporosis. And for the elderly, whose bones may be brittle to begin with, taking the drugs is adding insult to injury.

“It’s very unfortunate that they don’t get the treatment they need,” Siris told Reuters Health, referring to bisphosphonates.

About 10 million Americans suffer from osteoporosis, according to the National Osteoporosis Foundation, and the majority of them are postmenopausal women.

There are several alternative ways to treat osteoporosis, including hormone treatment for women. But bisphosphonates - such as Merck’s Fosamax, Roche’s Boniva, Novartis’s Reclast, and Warner Chilcott’s Actonel - remain the most popular option, and can be bought for as little as $10 per month in the U.S.

They come with their own set of side effects, however, including a rare breakdown of the jawbone called osteonecrosis and an unusual type of thigh fracture.

While steroids may be a necessary evil for some people, Dr. Gordon Schiff, associate director of the Center for Patient Safety Research and Practice at Brigham and Women’s Hospital in Boston, pointed out the irony of the situation.

Dr. Schiff, who wasn’t involved in the new research, told Reuters Health by email, “Here is one of those examples of using drugs to treat the consequences of using drugs. It should make us think twice in this situation and others where we get ourselves into this bind.”

SOURCE: Arthritis Care & Research, online July 17, 2012

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Prevalence of oral glucocorticoid usage in the United States: A general population perspective

Result
There were 356 NHANES respondents ≥20 years of age who reported use of an oral glucocorticoid in the combined cycles between 1999 and 2008. The weighted prevalence of oral glucocorticoid use was 1.2% (95% CI, 1.1-1.4) from 1999-2008, corresponding to 2,513,259 persons in the US. The mean duration of oral glucocorticoid use was 1605.7 days (95% CI, 1261.2-1950.1) and 28.8% (95% CI, 22.2-35.4) of oral glucocorticoid users reported use for ≥5 years. Concomitant use of a bisphosphonate was reported by 8.6% (95% CI, 5.1-11.7) of oral glucocorticoid users and 37.9% (95% CI, 31.7-44.0) reported usage of any anti-osteoporosis pharmaceutical.

Conclusio
Based on 1999-2008 NHANES data, it is estimated the prevalence of glucocorticoid use in the US is 1.2% with a long duration of use and infrequent use of anti-osteoporotic medications compared to other estimates.

  Robert A. Overman MPH,
  Jun-Yen Yeh PhD,
  Chad L. Deal MD