Efforts to prevent glucocorticoid-induced osteoporosis lacking

Majumdar SR. J Clin Endocrinol Metab. 2012;doi:10.1210/jc.2011-2645.

Issue: March 2012

Only one-quarter of patients initiating long-term glucocorticoid therapy receive bone mineral density testing or osteoporosis treatment, prompting researchers to call for improvements in glucocorticoid-induced osteoporosis preventive care.

Using the Manitoba Population Health Research Data Repository, Sumit R. Majumdar, MD, of the University of Alberta in Edmonton, Canada, and colleagues enrolled patients (mean age, 60 years; 58% women) who newly initiated long-term systemic glucocorticoids from 1998 to 2008. The researchers defined glucocorticoid-induced osteoporosis as the composite of BMD testing or osteoporosis treatment within 6 months of starting glucocorticoids.

More than 17,000 new long-term glucocorticoids initiations were studied, one-third of which involved prednisone and 64% of which were prescribed by general practitioners. Overall, 6-month rates were 6% for BMD testing, 22% for osteoporosis treatment and 25% for the composite of treatment and testing.

Researchers found modest increases in BMD testing (4% to 6%) from 1998 to 2008. Increases were also found in osteoporosis treatment (15% to 24%) and the composite of testing or treatment (17% to 27%; adjusted incidence rate ratio=1.51; 95% CI, 1.4-1.63). BMD testing from 6 months to 2 years after initiation of glucocorticoids showed a rate increase from 6% to 16%, according to study results. Rates of testing and treatment also increased from 25% to 32%.

According to multivariable analyses, women (34%) were more likely to receive high-quality glucocorticoid-induced osteoporosis preventive care vs. men (13%; P<.001). Additionally, patients with previous bone fractures had higher rates of osteoporosis testing or treatment (32%) than patients without previous fractures (25%). High-quality glucocorticoid-induced osteoporosis care varied among patients aged younger than 50 years (16%) and at least 70 years (27%; adjusted incidence rate ratio=0.57; 95% CI, 0.52-0.63), as well as within general practice (23%) and rheumatology (44%; adjusted incidence rate ratio=0.56; 95% CI, 0.52-0.6).

Overall, rates of glucocorticoids-induced osteoporosis care improvements have leveled off, the researchers said. They found at least 75% of patients who initiate glucocorticoids do not receive a BMD test or osteoporosis treatment within 6 months, which has important clinical consequences and medico-legal ramifications.

“Interventions to improve [glucocorticoid-induced osteoporosis] prevention need to be developed and tested in controlled trials, and these interventions might consider targeting young patients, men and general practitioners,” the researchers wrote.

Disclosure: The researchers report no relevant financial disclosures.

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