Osteoporosis Prophylaxis in Thyroid Eye Disease Patients on Intravenous Methylprednisolone
Author: Mumta Kanda
Base Hospital / Institution: Moorfields Eye Hospital, London
ePoster presentation
Abstract ID: 25-298
Purpose
The EUGOGO intravenous methylprednisolone (IVMP) protocol in thyroid eye disease (TED) exposes patients to high dose steroids for 12 weeks, increasing risk of steroid-induced osteoporosis. In addition, hyperthyroidism is an independent risk factor for osteoporosis. Despite this, there is lack of clear guidance on osteoporosis prophylaxis in this group. We run a high volume tertiary level complex TED clinic with many patients requiring IVMP and we aimed to create a new guideline based on national guidelines and expert recommendations.
Methods
We conducted a retrospective audit of osteoporosis prophylaxis management in adult patients started on IVMP for TED between September 2024 and March 2025 at Moorfields Eye Hospital. We compared our practice to standards for osteoporosis prophylaxis developed from the National Osteoporosis Guideline Group (NOGG) and National Institute of Clinical Excellence (NICE).
Results
NOGG/NICE guidance recommends the following for patients started on high-dose steroid: calcium and vitamin D supplementation in all patients of over 700mg calcium/day and over 400IU vitamin D/day; 1st line alendronate prescribed without delay in men age 50 or over and post-menopausal women; and fracture risk assessment/DXA scan in men age 50 or over and post-menopausal women. Our audit included 29 patients. Of the 20 (69%) female patients, 7 (35%) were considered post-menopausal (age 51 or over based on national average). Of the 9 (31%) male patients, 7 (78%) were age 50 or over. Calcium/vitamin D supplementation was prescribed in 89% of patients and of these, 69% were only prescribed half the recommended dose and 19% were not maintained on supplementation for the duration of steroid treatment. Bisphosphonate was prescribed in 0% patients. One patient was referred for a DXA scan.
Conclusion
Current practice at our unit does not meet national guidance on osteoporosis prophylaxis. Dosing of calcium/Vitamin D supplementation was too low, bisphosphonate was not prescribed, and referral for DXA scan was not done. We present an evidence-based protocol for osteoporosis prophylaxis in TED EUGOGO IVMP patients.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Allan | Nghiem | Moorfields Eye Hospital |
| Jimmy | Uddin | Moorfields Eye Hospital |
