title: Access to bone densitometry increases general practitioners' prescribing for osteoporosis in steroid treated patients.
abstract: BACKGROUND
  Availability of access to bone densitometry in the UK varies widely and there are concerns as to appropriate prescribing. Studies suggest inadequate use of osteoporosis prophylaxis in steroid users, despite recent guidelines.
  
  
  OBJECTIVE
  To examine in a case-control study whether access to bone densitometry affects GPs' osteoporosis prescribing in high risk steroid users.
  
  
  METHODS
  10 general practices were included, five from primary care trusts (PCTs) with access to bone densitometry and five with limited access. Patients receiving prednisolone for >3 months were identified by database search. Patients receiving no prophylaxis other than calcium and vitamin D (Ca/D) were subsequently included. Appropriate patients in five practices were offered DXA scan (cases) and review. Patients in practices without access to scans (controls) were reviewed. GPs' opinions leading to treatment were sought by structured questionnaire.
  
  
  RESULTS
  132 (0.12%) patients were receiving prednisolone for >/=3 months, but no osteoporosis prophylaxis other than Ca/D. Pre-study prophylaxis ranged from 18 to 36%. Of 48 patients scanned, 21 (44%) were abnormal and 18 (38%) received new treatment. 13/44 (30%) controls received new treatment. 10/21 (48%) with abnormal scans started a bisphosphonate, compared with 7/44 (16%) controls (RR = 3, p = 0.004). No difference in risk factors for fracture was found in treated and untreated controls.
  
  
  CONCLUSIONS
  GPs were three times more likely to start potent osteoporosis treatment after abnormal scans than GPs relying on clinical information. In practice, risk factors were not adequately assessed. Database searches may identify patients needing osteoporosis prophylaxis; however, DXA enables more appropriate patient treatment.
authors.affiliation: Department of Rheumatology, Queen Elizabeth Hospital, Greenwich, London, SE18, UK. ldolan@btinternet.com
authors.forename: A L
authors.initials: AL
authors.lastname: Dolan
authors.forename: E
authors.initials: E
authors.lastname: Koshy
authors.forename: M
authors.initials: M
authors.lastname: Waker
authors.forename: C M
authors.initials: CM
authors.lastname: Goble
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D003430:Cross-Sectional Studies; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D033181:Information Dissemination; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control*; D010818:Practice Patterns, Physicians'; D011239:Prednisolone / Q000627:therapeutic use*
chemical_list: D004164:Diphosphonates; D005938:Glucocorticoids; D011239:Prednisolone