title: Quality assurance study of the use of preventative therapies in glucocorticoid-induced osteoporosis in early inflammatory arthritis: results from the CATCH cohort.
abstract: OBJECTIVE
  To characterize steroid use and compliance with glucocorticoid-induced osteoporosis (GIOP) guidelines within a large early inflammatory arthritis cohort.
  
  
  METHODS
  Using the Canadian Early Arthritis Cohort (CATCH) database, patients with inflammatory arthritis on glucocorticoids (oral, IA and i.m.) were identified. Consecutive steroid exposure was defined as using glucocorticoids for two consecutive clinic visits (at least 90 days apart). The primary outcome was the proportion of patients receiving calcium, vitamin D and a bisphosphonate among patients treated with consecutive oral glucocorticoids.
  
  
  RESULTS
  Six hundred and fifty-five patients were in the CATCH database, where 273 patients were identified as glucocorticoid users, of whom 48% were on oral prednisone, 38% received i.m. or IA and 13% both. The median oral daily dose of prednisone was 5 mg (interquartile range 2.5-10). Consecutive users (CUs, n = 78) compared with non-consecutive users (NUs, n = 532) showed that CUs were older (56 vs 50 years, P = 0.001); females were fewer (63% vs 74%, P = 0.04), but a similar proportion were RF positive (51% in CU vs 56% in NU, P = 0.73). For the primary outcome, rates of prophylaxis for users of consecutive oral steroids were as follows: 53% were treated with calcium, 47% with vitamin D and 25% were on a bisphosphonate. For users of oral prednisone at doses ≥7.5 mg/day, rates of prophylaxis were as follows: 64% were treated with calcium, 57% with vitamin D and 21% were on a bisphosphonate.
  
  
  CONCLUSIONS
  Glucocorticoid therapy is frequently used in early inflammatory arthritis. The use of calcium, vitamin D or a bisphosphonate was low among chronic glucocorticoid users and illustrates the need for more diligence in patients receiving glucocorticoids to prevent GIOP.
authors.affiliation: St Joseph's Health Care, 268 Grosvenor St., London, Ontario, Canada.
authors.forename: Emily
authors.initials: E
authors.lastname: McKeown
authors.forename: Vivian P
authors.initials: VP
authors.lastname: Bykerk
authors.forename: Faye
authors.initials: F
authors.lastname: De Leon
authors.forename: Ashley
authors.initials: A
authors.lastname: Bonner
authors.forename: Carter
authors.initials: C
authors.lastname: Thorne
authors.forename: Carol A
authors.initials: CA
authors.lastname: Hitchon
authors.forename: Gilles
authors.initials: G
authors.lastname: Boire
authors.forename: Boulos
authors.initials: B
authors.lastname: Haraoui
authors.forename: Diane S
authors.initials: DS
authors.lastname: Ferland
authors.forename: Edward C
authors.initials: EC
authors.lastname: Keystone
authors.forename: Janet E
authors.initials: JE
authors.lastname: Pope
mesh_terms: D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002118:Calcium / Q000008:administration & dosage; D015331:Cohort Studies; D016208:Databases, Factual; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control*; D011241:Prednisone / Q000009:adverse effects*; D011785:Quality Assurance, Health Care; D013997:Time Factors; D014807:Vitamin D / Q000008:administration & dosage
chemical_list: D050071:Bone Density Conservation Agents; D005938:Glucocorticoids; D014807:Vitamin D; D002118:Calcium; D011241:Prednisone