Endocrine Abstracts (2002) 3 P247

The prevalence and morbidity of long-term oral corticosteroid therapy

JH Mackie, MS Cooper & PM Stewart

Division of Medical Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, UK.

Background: The adverse effects of corticosteroid therapy are similar to those of endogenous glucocorticoid excess. Previous studies have established the usage patterns of oral corticosteroids in the primary healthcare setting, but these have concentrated on corticosteroid-induced osteoporosis. The aim of this study was to investigate the prevalence and morbidity of long-term oral corticosteroids in a General Practice setting.

Methods: From a population of 12776 registered adult patients (6549 female, 6227 male), those currently be taking oral corticosteroids for a period of longer than 3 months were identified and invited to take part in the study. Ethical approval was granted.

Results: 103 adult patients (60 female), median age 72 years (range 22-92), were taking oral corticosteroids for greater than 3 months. This represents 0.8% of the total adult population, and 3.1% of those over 70 years. The most commonly prescribed steroid was prednisolone (93%, 96/103), and the mean dose was 6.68 mg/day with a median duration of 39 months (range 3-456). The most common indications for oral corticosteroids were polymyalgia rheumatica and temporal arteritis (40%) and rheumatoid arthritis (16%). 65% of those taking oral corticosteroids were also receiving osteoporosis prophylaxis, increasing to 71% in postmenopausal females, with the most common being the bisphosphonates. 67 patients (43 female) were interviewed (65%). When compared to an age-sex matched control population, the most prevalent corticosteroid associated side-effects were weight gain, facial rounding, increased appetite, telangiectasia, bruising, thin skin, fatigue and lethargy, reduced BMD (p < 0.001), muscle weakness (p < 0.01) and diabetes mellitus, irritability/mood swings, depression, impaired healing, bloatedness and lack of underarm hair (p < 0.05).

Conclusions: Long-term oral corticosteroids are used widely in general practice for a number of indications. The mean maintenance dose is lower than previously reported, and encouragingly the use of osteoporosis prophylaxis is increasing. The morbidity associated with corticosteroid use is considerable, thus, a constant individual reappraisal of the need for corticosteroid therapy is warranted.

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