title: Glucocorticoid-induced osteoporosis management among seniors, by year, sex, and indication, 1996-2012.
abstract: We identified that glucocorticoid-induced osteoporosis management (bone mineral density testing or osteoporosis treatment) among seniors improved among men (2 to 23 %) and women (10 to 48 %) between 1996 and 2007, and then remained relatively stable through to 2012. Differences were also noted by indication (from a low of 21 % for respiratory conditions to a high of 41 % for rheumatic conditions).
  
  
  OBJECTIVE
  The aim of our study was to describe the proportion of chronic oral glucocorticoid (GC) users that receive osteoporosis management (bone mineral density test or osteoporosis treatment) by sex and over time.
  
  
  METHODS
  We identified community-dwelling older adults initiating chronic oral GC therapy in Ontario using pharmacy data from 1996 to 2012. Chronic GC use was defined as greater than or equal to two oral GC prescriptions dispensed and ≥450 mg prednisone equivalent over a 6-month period. Osteoporosis management within 6 months of starting chronic GC therapy was examined by sex, year, indication for therapy, and osteoporosis management history. Results were summarized using descriptive statistics.
  
  
  RESULTS
  We identified 72,099 men and 95,975 women starting chronic oral GC therapy (mean age = 74.9 years, SD = 6.5). Approximately two thirds of patients (65 %) received ≥900 mg within the 6-month chronic use window. GC-induced osteoporosis management increased from 2 to 23 % (men) and 10 to 48 % (women) between 1996 and 2007, and then remained relatively stable through to 2012. A higher proportion of patients with prior osteoporosis management were managed within 6 months (56 % men, 67 % women) of chronic GC use, compared to patients without prior management (12 % men, 23 % women). Patients with rheumatic disease were managed most commonly (41 %), and patients with respiratory conditions were managed least commonly (21 %).
  
  
  CONCLUSIONS
  GC-induced osteoporosis management improved significantly over time for both sexes yet remains low. Significant care gaps by sex and between clinical areas represent a missed opportunity for fracture prevention among patients requiring chronic GC therapy.
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada.
authors.forename: J M
authors.initials: JM
authors.lastname: Albaum
authors.affiliation: Queen's University, Kingston, ON, Canada.|Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
authors.forename: L E
authors.initials: LE
authors.lastname: Lévesque
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.|Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: A S
authors.initials: AS
authors.lastname: Gershon
authors.affiliation: Queen's University, Kingston, ON, Canada.|Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Liu
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada. s.cadarette@utoronto.ca.|Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. s.cadarette@utoronto.ca.
authors.forename: S M
authors.initials: SM
authors.lastname: Cadarette
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D019468:Disease Management; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004363:Drug Utilization / Q000639:trends; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006302:Health Services Research / Q000379:methods; D006801:Humans; D008297:Male; D009864:Ontario; D010024:Osteoporosis / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000517:prevention & control; D012737:Sex Factors
chemical_list: D050071:Bone Density Conservation Agents; D005938:Glucocorticoids
keywords: Glucocorticoids; Health services research; Osteoporosis; Practice patterns