Corticosteroid-induced osteoporosis prevention: longitudinal practice patterns in The Netherlands 2001-2005.
We investigated prevention trends and predictors for osteoporosis prevention in long term corticosteroid users. The use of bisphosphonates increased from 2001 to 2005. Longer duration of corticosteroid use and DMARD use were predictors for receiving prevention. Females appear reasonably well treated; however, men require more attention.


BACKGROUND
Previous studies have shown that long-term corticosteroid users are undertreated for osteoporosis prevention. Our aim was to identify prevention trends in long-term corticosteroid users from 2001-2005 in The Netherlands and to identify predictors for bisphosphonate prophylaxis.


METHODS
Pharmacy dispensing data were used from 9 community pharmacies. All oral corticosteroid doses were converted to "prednisolone equivalents". We then identified long-term (> or =90 days) corticosteroid episodes, which required bisphosphonate prophylaxis as per 2002 Dutch guidelines; Multivariate logistic regression was used to identify predictors for receiving prevention.


RESULTS
We identified 615 different corticosteroid patients requiring prophylaxis. From 2001-2005 the use of bisphosphonates increased from 38% to 54% (p = 0.001). In 2005 females were prescribed more bisphosphonates than males (61% vs. 39%; p = 0.002), or any treatment (72% vs. 45%; p < 0.001). Multivariate analysis showed that longer duration of corticosteroid use and disease-modifying anti-rheumatic drug (DMARD) use were independent predictors of bisphosphonate use. Use of respiratory medication was a negative predictor of bisphosphonate use.


CONCLUSIONS
There has been a significant increase in osteoporosis prophylaxis in a population at high risk for osteoporosis/fractures. In particular, females appear reasonably well treated; however, men are still not receiving prevention to the same degree as women.
Duyvendak
M
M
Department of Clinical Pharmacy, Tjongerschans Hospital, Heerenveen, The Netherlands. mduyvendak@tjongerschans.nl
Naunton
M
M
Atthobari
J
J
van den Berg
P B
PB
Brouwers
J R B J
JR
D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D004164:Diphosphonates / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D050723:Fractures, Bone / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010024:Osteoporosis / Q000139:chemically induced / Q000188:drug therapy / Q000517:prevention & control*; D011239:Prednisolone / Q000009:adverse effects; D012737:Sex Factors; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D018501:Antirheumatic Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D011239:Prednisolone