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| Title | Bone protection in TED Patients receiving IVMP: A service improvement project |
| Number | 301 |
| Author | Mumta Kanda |
| Principal Unit where research was undertaken | Moorfields Eye Hospital |
| Purpose | The EUGOGO intravenous methylprednisolone (IVMP) protocol in thyroid eye disease (TED) exposes patients to high dose steroids for 12 weeks, increasing risk of glucocorticoid-induced osteoporosis (GIO). 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 closed-loop audit of osteoporosis prophylaxis management in adult patients started on IVMP for TED between September 2024 and January 2026 at Moorfields Eye Hospital. |
| Results | Primary audit showed calcium/vitamin D supplementation was prescribed in 89% of patients and of these, 69% were prescribed half the recommended dose. Bisphosphonate was prescribed in 0% high-risk patients. We implemented an osteoporosis prophylaxis protocol, developed alongside a consultant rheumatologist, into our TED service. At 6 months, there was a 90% improvement in bisphosphonate (p<0.001) and 20% improvement in calcium/vitamin D (p=0.090) prescribing. There was a 44% improvement in onward referral for fracture risk assessment and DXA scanning. |
| Conclusion | GIO may be under-recognised in TED patients receiving high-dose IVMP. In collaboration with rheumatology colleagues, we developed a protocol to standardise osteoporosis risk assessment and prophylaxis, leading to improved prescribing and referral rates. Greater awareness of GIO risk is important to support holistic management in this complex patient group. |
Additional Authors
| First name | Last name | Hospital / Institution |
|---|---|---|
| Allan | Nghiem | |
| Ali | Jawad | |
| Jimmy | Uddin |
