Management of glucocorticoid-induced osteoporosis in patients with rheumatoid arthritis: rates and predictors of care in an academic rheumatology practice.
OBJECTIVE
To examine rheumatologists' management practices for patients with rheumatoid arthritis (RA) taking glucocorticoids seen at one academic medical rheumatology practice.


METHODS
All patients diagnosed with RA making at least 2 visits to the practice who were noted to be taking glucocorticoids on an index visit in January or February 1999 were included in a retrospective chart review.


RESULTS
Of the 623 eligible patients identified with RA, 236 patients were taking glucocorticoids at their index visit and were included in this study. The mean daily dosage of prednisone (or its equivalent) was 8.8 mg and the mean duration of use during the 2-year chart review was 15.4 months. Twenty-three percent of the study population underwent bone densitometry, and 42% were prescribed a medication that reduces bone loss (not including calcium and/or vitamin D). Calcium and/or vitamin D were noted on the medication lists of 25% of patients. Factors associated with not undergoing bone densitometry in adjusted logistic models included male patient sex and premenopausal status in women. No physician factors were significantly related to performing bone densitometry. Variables associated with not receiving prescription treatment of osteoporosis were male patient sex, premenopausal status, and having at least 1 comorbid condition.


CONCLUSIONS
Patients with RA taking oral glucocorticoids did not routinely undergo bone densitometry and/or receive prescription medications for osteoporosis. Men and premenopausal women were less likely to undergo bone densitometry and to receive a prescription medication for osteoporosis than postmenopausal women. Interventions to improve detection and prevention of glucocorticoid-induced osteoporosis are necessary.
Solomon
Daniel H
DH
Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. dhsolomon@partners.org
Katz
Jeffrey N
JN
Jacobs
Jonathan P
JP
La Tourette
Alison M
AM
Coblyn
Jonathan
J
D000046:Academic Medical Centers; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D015519:Bone Density; D002983:Clinical Competence; D005260:Female; D005544:Forecasting; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D017698:Postmenopause; D017410:Practice Guidelines as Topic; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D011364:Professional Practice; D012189:Retrospective Studies; D012219:Rheumatology / Q000379:methods
D018501:Antirheumatic Agents; D005938:Glucocorticoids; D011241:Prednisone