title: Doctors' beliefs and knowledge on corticosteroid-induced osteoporosis: identifying barriers to improve prevention.
abstract: OBJECTIVE
  Despite the availability of effective treatments for the management of corticosteroid-induced osteoporosis (CIOP), the condition is undertreated. Our objective was to assess prescribers' knowledge and likely prescribing patterns concerning the diagnosis and treatment of CIOP. Another goal was to identify key barriers to the use of preventive therapy in patients using long-term corticosteroids.
  
  
  METHODS
  We used a postal survey of general practitioners (GPs) and specialists in the Netherlands. The survey comprised of questions on: demographic data, perceived barriers to the use of preventive therapy for CIOP, and knowledge of diagnosis and treatment of CIOP. Case scenarios were questioned to assess practice patterns.
  
  
  RESULTS
  Responding prescribers correctly answered an average of 55% of knowledge questions and 69% of case scenarios. Multiple questions and cases showed that knowledge on the use of bone mineral density (BMD) determination was poor. BMD was determined in patients who, according to the national osteoporosis guideline, should be treated with bisphosphonates independent of BMD. Moreover, only 18% of doctors correctly answered that the BMD cutoff in CIOP patients is a T-score of ≤-1 or ≤-1·5. Key barriers identified were: (i) GPs, significantly more than specialists, consider prescription of preventive therapy the responsibility of another doctor; (ii) discontinuation of anti-resorptive medication due to adverse effects and (iii) the reluctance to prescribe preventive therapy in patients already prescribed multiple medications.
  
  
  CONCLUSIONS
  Doctors did not identify many barriers to the prescribing of anti-resorptive therapies. Lack of knowledge, especially concerning use of BMD-results, likely led to the under-treatment of the presented patients.
authors.affiliation: Department of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, The Netherlands. m.duyvendak@rug.nl
authors.forename: M
authors.initials: M
authors.lastname: Duyvendak
authors.forename: M
authors.initials: M
authors.lastname: Naunton
authors.forename: E N
authors.initials: EN
authors.lastname: van Roon
authors.forename: J R B J
authors.initials: JR
authors.lastname: Brouwers
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D001291:Attitude of Health Personnel; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use; D002983:Clinical Competence; D016903:Drug Monitoring; D005260:Female; D058005:General Practitioners / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010024:Osteoporosis / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy; D010819:Physician's Role / Q000523:psychology; D010820:Physicians / Q000523:psychology*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D013038:Specialization; D011795:Surveys and Questionnaires
chemical_list: D000305:Adrenal Cortex Hormones; D050071:Bone Density Conservation Agents