OBJECTIVES: Consensus guidelines for bone management of patients taking 
corticosteroids suggest two main interventions: Dual energy X-ray absorptiometry 
(DEXA) scanning in those taking prednisolone > or =7.5 mg daily for > or =6 
months (repeated every 1-3 years as indicated). Bisphosphonate therapy for those 
taking prednisolone > or =15 mg daily for > or =6 months regardless of DEXA 
result, and also for patients with known or high risk of developing osteoporosis 
(including those aged >65 years).
MATERIAL AND METHODS: We audited adherence to these guidelines in all adults 
with myasthenia gravis (MG) attending our neurology service.
RESULTS: Of 80 patients with MG (47 male, mean age 63.3 years), 34 (43%) had 
received corticosteroids for > or =6 months. Eighteen were taking prednisolone > 
or =7.5 mg daily (mean dose 16.6 mg) yet only 4 of these (22%) had undergone 
DEXA scanning. Of the 13 patients meeting the guideline criteria to receive 
bisphosphonate therapy, this was prescribed to only 7 (54%). Two others were 
prescribed vitamin D, 2 a calcium supplement and 2 were receiving no 
prophylaxis.
CONCLUSION: In these MG patients the guidelines were followed in only a 
minority. Neurologists need greater awareness of the bone health consequences of 
prescribing long-term corticosteroids.