title: Management and treatment of osteoporosis in patients receiving long-term glucocorticoid treatment: current status of adherence to clinical guidelines and related factors.
abstract: OBJECTIVE
  The aim of this study was to evaluate the adherence of guidelines for the management and treatment of glucocorticoid-induced osteoporosis, and to investigate whether it is associated with factors such as age, gender, glucocorticoid dose, physician specialty, and size of facility.
  
  
  METHODS
  This was a cross-sectional study utilizing administrative data from a database of health insurance claims (2004-2007); 2,368 patients who received glucocorticoid treatment for ≥90 days were extracted. The guideline adherence was determined by evaluations based on glucocorticoid prescription dose, prescription of anti-osteoporosis drugs, and whether or not bone mineral density was measured.
  
  
  RESULTS
  Overall proportion of guideline adherence was 23.3%. In cases in which the equivalent dose of prednisolone was <5 mg/d and ≥5 mg/d, the adherence was 8.3% and 30.5% respectively. Factors correlating with low adherence included young age, male gender, and lower glucocorticoid doses. Surgery and otolaryngology specialties had lower adherence than internal medicine. Smaller clinical facilities had lower adherence than larger facilities.
  
  
  CONCLUSIONS
  The adherence of guidelines for the management and treatment of glucocorticoid-induced osteoporosis is still low, and improvements in treatment quality can be expected through education of patient groups and medical care providers with large deviations from the guidelines.
authors.affiliation: Japan Association for Development of Community Medicine, Japan.
authors.forename: Daijun
authors.initials: D
authors.lastname: Kirigaya
authors.forename: Takeo
authors.initials: T
authors.lastname: Nakayama
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Ishizaki
authors.forename: Shunya
authors.initials: S
authors.lastname: Ikeda
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Satoh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced* / Q000188:drug therapy* / Q000378:metabolism; D017410:Practice Guidelines as Topic; D055815:Young Adult
chemical_list: D050071:Bone Density Conservation Agents; D005938:Glucocorticoids