From the Guidelines
Dexa should be stopped when the patient's bone mineral density (BMD) is stable, and the risk of osteoporosis is low, as indicated by a T-score above -1.5, and the patient is no longer at risk of rapid bone loss. When to stop Dexa depends on various factors, including the patient's underlying condition, BMD, and risk of osteoporosis. According to the EASL clinical practice guidelines on nutrition in chronic liver disease 1, Dexa scans should be repeated after 2-3 years in patients with normal BMD, and within 1 year when rapid bone loss is expected. The decision to stop Dexa should be based on the patient's individual risk factors, such as age, BMI, steroid use, and presence of associated inflammatory bowel disease (IBD) 1. It is essential to assess the patient's fracture risk using online calculators, such as FRAX, and evaluate their individual fracture risk after Dexa scans 1. Regular monitoring of the patient's BMD and risk factors is crucial to determine when to stop Dexa and prevent osteoporosis and fractures. Key factors to consider when deciding to stop Dexa include:
- The patient's T-score, with a score above -1.5 indicating a low risk of osteoporosis
- The patient's risk of rapid bone loss, with factors such as steroid use and IBD increasing the risk
- The patient's overall health and presence of underlying conditions, such as chronic liver disease or PSC
- The patient's age, BMI, and other individual risk factors for osteoporosis.
From the Research
Stopping Dexa: Considerations and Evidence
- The decision to stop dexa (dexamethasone) should be based on individual patient needs and response to treatment, as well as the specific condition being treated 2, 3, 4, 5.
- In patients with chronic inflammatory demyelinating polyneuropathy (CIDP), treatment with corticosteroids, including dexamethasone, can be effective in improving symptoms and inducing remission 2.
- However, the optimal duration of treatment and the criteria for stopping treatment are not well established, and may depend on factors such as disease severity, response to treatment, and presence of adverse effects 2, 4.
- In patients with cancer-related pain, corticosteroids, including dexamethasone, may be used to manage pain and inflammation, but the evidence for their efficacy is limited, and the optimal duration of treatment is not well established 4.
- The use of dexamethasone in combination with immune checkpoint inhibitors may have differential effects on T cell function, and the decision to stop treatment should take into account the individual patient's response to treatment and the presence of adverse effects 5.
- Factors to consider when deciding to stop dexa include: