A Local Clinical Audit on Osteoporosis Prevention and Management in Sudanese Patients Treated with Long Term Oral Glucocorticoids for Rheumatic Diseases in a Military Tertiary Hospital in West Khartoum

Background: Glucocorticoids (GC) are considered a mainstay as well as symptomatic and disease-modifying therapy for rheumatic diseases. They are generally used to quickly dampen inflammation, reduce duration of disease flares and as a maintenance therapy. Conventionally, oral GC are to be prescribed for short periods when possible; mainly, because of their side effects when used for long periods. One of the most important drawbacks of prolonged GC therapy is the risk of bone loss (osteoporosis (OP)) and osteoporotic fragility fracture (OFF). Objective: The aim of this audit was to assess counselling, prevention and management of OP in patients with rheumatic conditions who are or were receiving high doses of oral GC for three months or more against standard international guidelines. Method: The audit was carried out in March/April 2018 for a period of four weeks in a busy rheumatology service in Khartoum, Sudan. A Performa was used to collect data manually from eligible patients and their outpatient medical cards retrospectively. Then, data were audited against standard guidelines. Result: Overall, the selected Centre failed to meet the audit standard of 50% of eligible patients being appropriately managed for OP/OFF according to NICE and ACR guidelines. Conclusion: Huge areas of deficiency in the practice were identified. Acknowledging socioeconomic difficulties in the area of study, simple measures, such as carrying out a fracture risk assessment, optimizing calcium and vitamin D supplements with life style modification and patient education, would have a great impact on patients treated with steroids for rheumatic diseases.