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Osteoporosis prevention in myasthenia gravis: a reminder


P. E. M. Smith, Department of Neurology, University Hospital of Wales, Cardiff CF4 4XW, UK
Tel.: 01222 742834


Objectives– Consensus guidelines for bone management of patients taking corticosteroids suggest two main interventions: Dual energy X-ray absorptiometry (DEXA) scanning in those taking prednisolone ≥7.5 mg daily for ≥6 months (repeated every 1–3 years as indicated). Bisphosphonate therapy for those taking prednisolone ≥15 mg daily for ≥6 months regardless of DEXA result, and also for patients with known or high risk of developing osteoporosis (including those aged >65 years). Material and methods– We audited adherence to these guidelines in all adults with myasthenia gravis (MG) attending our neurology service. Results– Of 80 patients with MG (47 male, mean age 63.3 years), 34 (43%) had received corticosteroids for ≥6 months. Eighteen were taking prednisolone ≥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. Conclusion– 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.