title: Bone health in a tertiary-care gastroenterology and hepatology population.
abstract: BACKGROUND
  Glucocorticoid use is a major risk factor for osteoporosis. Overall rates of glucocorticoid use and bone health preventive measures in gastroenterology and hepatology populations are unknown.
  
  
  OBJECTIVE
  We aimed to determine the rates of glucocorticoid use and bone health preventive measures, to evaluate an education-based quality improvement initiative on bone health and to assess improvement in health-care practices of providers in regard to bone health recommendations.
  
  
  METHODS
  A cross-sectional survey was offered to all patients visiting a tertiary care gastroenterology and hepatology clinic. A bone health education intervention was performed, followed by a repeat cross-sectional survey. Pearson's Chi-square test statistic was used to evaluate interval improvement in bone health recommendations with the intervention. Predictive multiple logistic regression modeling was used to determine factors that influenced bone health recommendations by providers.
  
  
  RESULTS
  A total of 552 patients and 725 patients completed the pre and post-intervention questionnaires, respectively. The prevalence of glucocorticoid use was 12.9%. Bone health recommendations to patients on glucocorticoids did not improve with the intervention (63.0% vs. 55.4%, p = 0.42). The strongest predictor of bone health recommendations was autoimmune hepatitis (OR 6.60 95%CI 3.13, 13.90), followed by inflammatory bowel disease (OR 6.06 95%CI 3.92, 9.38), liver disease (OR 3.70 95%CI 2.45, 5.59), current smoking (OR 3.31 95%CI 2.32, 4.73) and history of osteoporosis/osteopenia (OR 2.72 95%CI 1.83, 4.03).
  
  
  CONCLUSIONS
  In spite of risk factors for osteoporosis in patients with digestive diseases, health-care practices by providers in regard to bone health recommendations warrant further improvement.
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC 27599-7080, USA. millie_long@med.unc.edu
authors.forename: Millie D
authors.initials: MD
authors.lastname: Long
authors.forename: Michelle T
authors.initials: MT
authors.lastname: Thiny
authors.forename: Robert S
authors.initials: RS
authors.lastname: Sandler
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Gangarosa
mesh_terms: D000328:Adult; D002118:Calcium / Q000008:administration & dosage / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004164:Diphosphonates / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005767:Gastrointestinal Diseases / Q000188:drug therapy*; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use*; D006801:Humans; D008107:Liver Diseases / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced* / Q000517:prevention & control; D014807:Vitamin D / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D004164:Diphosphonates; D005938:Glucocorticoids; D014807:Vitamin D; D002118:Calcium