Longitudinal patterns in the prevention of osteoporosis in glucocorticoid‐treated patients

Abstract

Objective. To evaluate patient and physician factors associated with prevention of glucocorticoidinduced osteoporosis and to describe temporal trends in screening and prevention of glucocorticoid-induced osteoporosis.Methods. Using databases from a national managed care organization, enrollees who had been prescribed glucocorticoids (taken for at least 60 days) during an 18-month period were identified. Administrative data from January Conclusion. Despite significant temporal increases in the frequency of screening for and treatment of glucocorticoid-induced osteoporosis, absolute rates remain low, especially among men, African Americans, and patients of certain physician specialties.Glucocorticoids are prescribed widely in medical practice and are used by 0.5-2.5% of adults (1,2). Despite the acknowledged benefits of glucocorticoid treatment in controlling short-term inflammation, concerns about associated adverse events often limit its use. Among the most feared is glucocorticoid-induced osteoporosis. Rates of glucocorticoid-induced osteoporosisassociated fracture may approach 40% in selected populations (3,4), and this condition often results in

Prevalence of oral glucocorticoid usage in the United States: A general population perspective

“…These fractures can lead to increased pain, decreased quality of life, and in some cases, increased mortality (3). There are antiosteoporosis pharmaceuticals that have been shown to be efficacious and are recommended by clinical societies (4,5), but studies of long-term oral glucocorticoid users have indicated their use in less than 40% of the population (6,7).…”

“…Previous studies related to oral glucocorticoid and antiosteoporosis pharmaceutical use in the US were limited to long-term oral glucocorticoid users only (6,7). Their estimates provide an incomplete view of oral glucocorticoid use in the US general population and prevent a fair comparison of epidemiologic estimates between the US population and those in other countries.…”

Use of a Computerized Order Set to Increase Prescription of Calcium and Vitamin D Supplementation in Patients Receiving Glucocorticoids

“…Curtis et al 10 reviewed a database of patients on glucocorticoids from a national managed care organization and reported that 51 % of physicians, across all specialties, prescribed calcium and vitamin D, and 55 % of rheumatologists prescribed calcium and vitamin D. A retrospective chart review of 100 patients receiving long-term glucocorticoids at an academic Veterans Affairs (VA) Medical Center revealed that 32 patients were prescribed calcium supplementation and 12 patients were prescribed vitamin D. 11 Several interventions have been developed to improve adherence to recommendations to prevent GIOP. [12][13][14] At one US academic center, a trial randomized 21 rheumatologists caring for 373 chronic glucocorticoid users to an intervention consisting of a lecture, discussion and confidential physician audit of practice patterns. 12 No subsequent differences in the rates of prescribed therapies for GIOP were observed in the intervention group compared with the control group.…”

Validation of the Male Osteoporosis Risk Estimation Score (MORES) in a Primary Care Setting

“…[1][2][3][4][5][6][7] Because low bone mineral density (BMD) is the single best predictor of future fragility fractures, 8 -10 identifying men at increased risk for osteoporosis who should undergo a dual-energy X-ray absorptiometry (DXA) scan may be worthwhile.…”