Corticosteroid-Induced Osteoporosis

Route Planning, Glencoe

At the Drift Inn, Arran

Only 3 days to go now until the marathon. Can't wait to get it over with! Went out for the last run today and apart from a bit of 'runner's knee' feeling generally ok. The last couple of weekends have been busy so looking forward to a week off next week.

I've decided on a new audit to start whilst I'm working in the dermatology department. A couple of ideas were suggested, such as monitoring of second line psoriasis treatments eg. acitretin (too similar to my last audit) and investigating melanomas referred to secondary care as 'routine' when they should have been urgent (very interesting and important but difficult). I've settled on the topic which my supervisor had suggested - prevention and treatment of glucocorticoid-induced osteoprosis. The basis for this is that systemic glucocorticoids ie. prednisolone are commonly used and patients may be prescribed them long term for immunosuppression. Patients on prednisolone for greater than three months are at increased risk of complications eg. fragility fractures and avascular necrosis of the femoral head. National and local guidelines recommend that patients greater than old should be given bone-protective therapy at the time of starting corticosteroids, whilst those less than 65 years old should be assessed for bone density following three months of treatment to determine fracture risk.

I'm also going to get back involved in the gentamicin project now that the initial audit and change has been carried out. I've just emailed out to the FY1 doctors working at the Victoria this year to recruit some volunteers to repeat the audit, now that the new prescribing and monitoring form is in place. Hopefully we can repeat the audit and see if gentamicin is being prescribed in a safer way now that the new form is being used.