Trends in prevention of glucocorticoid-induced osteoporosis.
OBJECTIVE
To determine longitudinal patterns and predictors for the utilization of bone mass measurements and anti-osteoporotic medications in the prevention of glucocorticoid-induced osteoporosis.


METHODS
Within a managed care population of 7 million persons, we identified 3,125 adult men and women who had initiated longterm glucocorticoid therapy (>or=7.5 mg/day of prednisone equivalent for > 6 mo). The study population was examined by 3 biennial intervals between years 1996 and 2001 for receipt of a bone mass measurement and use of anti-osteoporotic medication (bisphosphonate, calcitonin, raloxifene, hormone replacement therapy).


RESULTS
Receipt of a bone mass measurement increased among postmenopausal women from 10% in 1996-97 to 19% in 2000-01, but remained below 6% in all biennial intervals among women under age 50 and men. The use of anti-osteoporotic medication was most common among postmenopausal women, where it approached 50%. The largest absolute increase in anti-osteoporotic medication utilization was among women ages 65 and over, increasing from 24% in 1996-97 to 44% in 2000-01. The specialty of physician providing care was associated with receipt of both testing and treatment. Odds of receipt of a bone mass measurement and anti-osteoporotic medication were 3 to 4 times greater among patients of rheumatologists compared to those of internists or family practitioners.


CONCLUSIONS
Among patients initiating longterm glucocorticoid therapy, the proportion of individuals receiving a bone mass measurement or anti-osteoporotic medication remains relatively low, but has improved temporally among postmenopausal women.
Saag
Kenneth G
KG
UAB Center for Education and Research on Musculoskeletal Disorders, University of Alabama at Birmingham, 35294, USA. ksaag@uab.edu
Gehlbach
Stephen H
SH
Curtis
Jeffrey R
JR
Youket
Thomas E
TE
Worley
Karen
K
Lange
Jeffrey L
JL
D000293:Adolescent; D000328:Adult; D000368:Aged; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced* / Q000517:prevention & control*; D017698:Postmenopause; D011241:Prednisone / Q000009:adverse effects*; D011364:Professional Practice; D012219:Rheumatology / Q000639:trends*
D050071:Bone Density Conservation Agents; D005938:Glucocorticoids; D011241:Prednisone