title: Osteoporosis management among chronic glucocorticoid users: a systematic review.
abstract: BACKGROUND
  Clinical practice guidelines recommend that all patients starting chronic oral glucocorticoid (GC) therapy receive bone mineral density (BMD) testing and osteoporosis pharmacotherapy.
  
  
  OBJECTIVE
  We completed a systematic review of observational studies to examine the proportion of patients on chronic oral GC therapy who receive osteoporosis management.
  
  
  METHODS
  Two independent reviewers completed a systematic search of Ovid MEDLINE® and EMBASE® to identify all English language articles that examined the prevalence of osteoporosis management among chronic oral GC users. Clinical trials, abstracts, reviews, commentaries, and letters to the editor were excluded. Study methods and results (use of BMD testing and osteoporosis pharmacotherapy) were abstracted and summarized by year and region.
  
  
  RESULTS
  We identified 29 eligible studies published between 1999 and October 2013: 17 were conducted in North America, 5 in Europe, and 7 in other regions. Heterogeneity between patient populations and methods used to define chronic GC use precluded the direct comparison of results between regions, or over time. Over 80% of studies identified that < 40% of chronic oral GC users received BMD testing or osteoporosis pharmacotherapy. When results of these studies were plotted by year, there was little evidence of improvement in osteoporosis management over time.
  
  
  CONCLUSIONS
  Despite consistent recommendations to target osteoporosis prevention at the onset of chronic oral GC therapy, osteoporosis is undermanaged among chronic oral GC users. Targeted interventions are needed to help reduce the burden of fracture-related morbidity associated with GC-induced osteoporosis.
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Albaum
authors.forename: Soyoung
authors.initials: S
authors.lastname: Youn
authors.forename: Linda E
authors.initials: LE
authors.lastname: Levesque
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Gershon
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Cadarette
mesh_terms: D000284:Administration, Oral; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D019983:Guideline Adherence; D006801:Humans; D064887:Observational Studies as Topic; D010024:Osteoporosis / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D005938:Glucocorticoids