Systematic review of trends in prophylaxis of corticosteroid-induced osteoporosis: the need for standard audit guidelines.
Corticosteroid-induced osteoporosis (CIOP) is currently undertreated. Systematic review of the literature revealed that the percentage of patients treated adequately is dependent on study quality. Therefore, it remains unknown whether adherence to the guidelines is really so poor. Five major quality criteria provide the standard for future studies on this scope.


BACKGROUND
It has recently been stated that the degree of prophylaxis of corticosteroid-induced osteoporosis (CIOP) is low and effort should be put into determining reasons for non-prescribing of preventive agents. The aim of this study was to identify: how many studies adequately audit the prevalent guideline; the longitudinal trends in prevention of CIOP; which patient groups appear to be most undertreated; and which intervention strategies are effective.


METHODS
We performed a comprehensive search of MEDLINE and systematically recorded the outcomes and quality of published studies, using five major criteria.


RESULTS
Twenty-four studies were included in the analysis. The quality of the included studies was poor (31%) or moderate (37%). There was a longitudinal increase in quality of the studies and percentage of prevention. Multivariable linear regression showed that the quality of the study was the only independent predictor of the prevention rate reported in the study.


CONCLUSIONS
The results show undertreatment of CIOP might be due to insufficient quality of the studies rather than poor practice or failure to recognise the right patients. Future interventions should comply with five major quality criteria, and a multifaceted approach is required in order to make an impact on the underprescribing of CIOP prophylaxis.
Duyvendak
M
M
Department of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Ant. Deusinglaan 1, 9713 AV, Groningen, The Netherlands. m.duyvendak@rug.nl
Naunton
M
M
van Roon
E N
EN
Bruyn
G A W
GA
Brouwers
J R B J
JR
D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000592:standards; D010024:Osteoporosis / Q000139:chemically induced* / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome
D050071:Bone Density Conservation Agents; D005938:Glucocorticoids