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Complaints against GPs rise

Government guidelines for giving patients on oral steroids medication to protect their bones should be extended to cover even those on low doses, a study suggests.

The analysis of 280,000 patients found that taking oral steroids at any dose for more than three months could substantially increase fracture risk.

Users of oral steroids across the range of doses were twice as likely to suffer a fracture as non-users. Women were particularly at risk, with users five times as likely to suffer a vertebral fracture as non-users.

The risk reduced when patients stopped taking steroids, but did not disappear.

The National Prescribing Centre currently advises GPs to give bone-protecting medication to patients who take 7.5mg a day or more of oral steroids for more than six months.

But research leader Dr Peter Donnan, senior lecturer in medical statistics at the University of Dundee, said the risk existed for lower doses and shorter periods: 'If you are on oral steroids for three months you are at risk of fracture. The risk is still there even at relatively low doses and cumulative, so you could be on it over a long time at a very low dose.'

Dr Donnan said the argument for lowering treatment thresholds was particularly strong for women. He said GPs should consider dietary advice, DEXA scans or treatment with bisphosphonates.

The retrospective cohort study, published in Pharmacoepidemiology and Drug Safety, estimated that as many as one in six vertebral and one in 13 non-vertebral fractures could be caused by oral steroids. In patients taking steroids, the drugs were likely to be responsible for three in every four vertebral fractures.

Previous fracture and medication for Parkinson's disease or epilepsy were significantly associated with increased risk, and use of HRT, NSAIDs and statins with reduced risk.

Dr Peter Stott, a GP in Tadworth, Surrey, and a member of the National Osteoporosis Society, said there was a 'big hole' in guidance, and that NICE should prioritise steroid users for protection. 'Not enough are on bone-preserving therapies,' he said.

RCGP prescribing lead Dr Jim Kennedy said the study underlined the need for close monitoring of patients.

By Nerys Hairon

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