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Prevention of Glucocorticoid-Induced Osteoporosis
Experience in a Managed Care Setting
Robert A. Yood, MD;
Leslie R. Harrold, MD, MPH;
Leslie Fish, PharmD;
Jackie Cernieux, MPH;
Srinivas Emani, MA;
Elisabeth Conboy, RN, BSN;
Jerry H. Gurwitz, MD
Arch Intern Med. 2001;161:1322-1327.
Background Treatment with glucocorticoids is the leading cause of drug-induced
osteoporosis. Currently available guidelines indicate that patients receiving
long-term glucocorticoid therapy should receive measures to prevent osteoporosis.
Objectives To examine whether patients receiving long-term glucocorticoid therapy
in a managed care setting received preventive therapy or prescribed medications
for osteoporosis and to identify patient and provider characteristics associated
with treatment.
Subjects and Methods A cohort of 224 health plan enrollees 20 years and older who were dispensed
at least 1 oral glucocorticoid prescription per quarter during the period
October 1997 through September 1998 was identified from administrative data.
Medical charts and administrative data were reviewed to determine use of preventive
therapy and prescribed medications for osteoporosis.
Results Of the 224 patients, 62% had at least 1 documented intervention aimed
at osteoporosis prevention (counseling about calcium or vitamin D or weight-bearing
exercise; prescription for estrogen, calcitonin, or bisphosphonate; or a bone
mineral density study). Women were more likely than men to receive intervention
(76% vs 44%; prevalence odds ratio, 4.41; 95% confidence interval, 2.17-9.10).
Patients receiving a mean daily prednisone dose of 10 mg or more or 5 to less
than 10 mg were no more likely to receive intervention than those receiving
5 mg or less prednisone daily. Sixty-two (90%) of 69 patients who were prescribed
glucocorticoid therapy by rheumatologists had at least 1 intervention documented
compared with 29 (48%) of 60 for internists, 26 (55%) of 47 for pulmonologists,
and 22 (46%) of 48 for all other physicians. In a multiple logistic regression
model, including patient age, sex, mean daily glucocorticoid dose, and physician
specialty, women and patients prescribed glucocorticoids by a rheumatologist
were significantly more likely to receive intervention aimed at osteoporosis
prevention.
Conclusions A substantial proportion of patients receiving long-term glucocorticoid
therapy do not receive preventive therapy for osteoporosis. Efforts should
be made to reduce barriers to such treatment and increase the proportion of
patients given preventive therapy.
From the Fallon Clinic, Inc (Drs Yood and Fish, Mr Emani, and Ms Conboy),
Meyers Primary Care Institute, Fallon Healthcare System, and the University
of Massachusetts Medical School (Drs Yood, Harrold, and Gurwitz and Ms Cernieux),
Worcester.
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