Practice patterns in osteoporosis prevention in patients on glucocorticoids [1]

We have read the recent results from the study on osteoporosis prevention in chronic (>90 days) glucocorticoid users by Feldstein et al. [1] and have three comments. 1. We believe that any apparent under-treatment may be partly due to the fact that the data analysed were collected from January 2000–December 2001. The American College of Rheumatology (ACR) guidelines for prevention of glucocorticoid-induced osteoporosis were published in July 2001 and recommended that osteoporosis prevention should be considered in those patients treated on ≥5 mg of prednisolone per day [3]. The guidelines available before this suggested that patients should be considered for osteoporosis prevention if the dose was greater than 7.5 mg per day, and the patients were treated for >6 months with the glucocorticoid [4]. We believe to be fair to the prescribers and other primary-care clinicians it should be noted that at the time that these data were collected most would only be aware that patients treated with ≥7.5 mg prednisolone should be considered for osteoporosis prevention.