Assessment of osteoporosis and fracture risk in people with interstitial lung disease, can we do better?

Oral corticosteroids (OCS) have an essential role in the treatment of many respiratory conditions, including interstitial lung disease (ILD). However, their use increases patient risk of osteoporosis and fractures. This avoidable harm can be minimised by assessing patients against National Osteoporosis Guideline Group recommendations and where necessary, prescribing appropriate “bone protection”. This study sought to investigate clinical practice at a tertiary ILD service in London. 123 sequential records were reviewed and 78 patients were found to be prescribed OCS. 65 met the criteria to receive bone protection (see table 1), but only 19 (29%) were prescribed appropriate bone protection (83% received calcium supplements, 91% vitamin D supplementation; 3% and 1% did not receive calcium/vitamin D supplements due to contraindications respectively). 2/19 stopped the OCS, but also had their bone protection stopped without reassessment of fragility risk, 1/19 had their bone protection therapy stopped despite ongoing high dose OCS. This cohort review highlights the need to improve identification of patients at risk of OCS-induced osteoporosis and support appropriate initiation and review of bone protective therapies. <fig><object-id>erj;64/suppl_68/PA4758/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>