Utilization of Preventive Measures for Glucocorticoid-Induced Osteoporosis among Veterans with Inflammatory Bowel Disease

Abstract

Purpose. We examined current osteoporosis prevention practices in patients with inflammatory bowel disease (IBD) on chronic steroid using the 2003 American Gastroenterological Association guidelines as standard of care. Methods. We identified all IBD patients followed at the Oklahoma City VA Medical Center from January 2003 to December 2010, who had been on daily oral steroids (prednisone ≥5 mg or budesonide ≥6 mg) for ≥3 consecutive months. Associations of calcium and vitamin D (vitD) prescribing and bone mineral density (BMD) testing with patient characteristics were examined by logistic regression. Results. Sixty-three of 384 consecutive patients met inclusion criteria. Among 86 steroid courses, calcium and vitD were concurrently prescribed in 46%, and BMD was tested in 30%. There was no association of demographic and clinical characteristics with calcium/vitD prescribing and BMD testing. By multivariate analysis, steroid initiation after 2006, compared to before 2006, was associated with a significant increase in calcium (OR = 3.17 and P = 0.02) and vitD (OR = 2.96 and P = 0.02) prescribing and BMD testing (OR = 4.63 and P = 0.004). Conclusions. We observed a low, yet increasing, adherence to osteoporosis prevention guidelines in IBD since 2003, which highlights the need for continued physician education to enhance guideline awareness and implementation.

Long-term Systemic Corticosteroid Exposure: A Systematic Literature Review

“…Additionally, the present review found that adherence to guideline-recommended therapies to prevent fracture remains low, likely due to low awareness. 12 Further research on how to accelerate the adoption of such prevention guidelines can greatly reduce the osteoporotic risks induced by corticosteroids.…”

“…One study found that, among certain populations, low, yet increasing, adherence to osteoporosis guidelines (eg, prescribing of calcium and vitamin D in long-term corticosteroid users) over the past decade have been observed. 12 Teriparatide, oral bisphosphonates, and physician education for improved management may be costeffective in specific populations in the prevention of glucocorticoid-induced osteoporosis. [13][14][15]40 It is important to determine methods of improving adherence to prevention guidelines via health system and health policy research.…”

MicroRNA and Human Bone Health

“…Glucocorticoid therapy used in treating autoimmune diseases, such as inflammatory bowel disease (IBD) and systemic lupus erythematosus (SLE), could lead to osteoporosis . IBD patients are known to have elevated proinflammatory circulating cytokine and increased risk of fracture .…”

Prescribing Pattern and Use of Steroids in Asthma Patients

“…Some of these may be potentially beneficial, but the majority are possibly detrimental. Interactions may even occur between more than two drugs simultaneously 8,9,10 . We pursued to determine the frequency of diverse patterns of asthma controller medication in the tangible clinical practice 11 .…”