title: Osteoporosis prevention among chronic glucocorticoid users: results from a public health insurance database.
abstract: BACKGROUND
  Long-term glucocorticoid therapy is the leading cause of secondary osteoporosis. The management of glucocorticoid-induced osteoporosis (GIOP) seems to be inadequate in many European countries.
  
  
  OBJECTIVE
  To evaluate the rate of screening and treatment of GIOP.
  
  
  METHODS
  Information was collected from a national public health-insurance database in our geographic area of Provence-Alpes-Côte-d'Azur and in Corsica, from September 2009 through August 2011.
  
  
  METHODS
  We identified participants aged 15 years and over starting glucocorticoid therapy (≥7.5 mg of prednisone equivalent per day during at least 90 days consecutive). This cohort was compared with an age-matched and sex-matched population that did not receive glucocorticoids.
  
  
  METHODS
  Bone mass, prescription of bone antiresorptive medication and use of calcium and/or vitamin D treatment.
  
  
  RESULTS
  We identified 32 812 patients who were prescribed glucocorticoid therapy, yielding 1% prevalence. Incidence of glucocorticoid therapy was 2.8/1000 inhabitants/year. Males represented 44%, the mean age was 58 years. The median prednisone-equivalent dose was 11 mg/day (IQR 9-18 mg/day). 8% underwent bone mass measurement. Calcium and/or vitamin D, and bisphosphonates were prescribed in 18% and 12%, respectively. Results were lower for the control population: 3% underwent bone mass measurement and 3% received bisphosphonate therapy. The rates of osteodensitometry and treatments were higher in women over 55 years of age than in men and women 55 years of age and younger, and also when glucocorticoid therapy was initiated by a rheumatologist versus other physician specialty.
  
  
  CONCLUSIONS
  The management of GIOP remains very inadequate, despite the availability of a statutory health insurance system. Targeted interventions are needed to improve the management of GIOP.
authors.affiliation: Service de Rhumatologie , APHM, Hôpital Sainte-Marguerite , Marseille , France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Trijau
authors.affiliation: Service de Rhumatologie, APHM, Hôpital Sainte-Marguerite, Marseille, France; Faculté de Médecine, Aix-Marseille Université, Marseille, France.
authors.forename: Gaëlle
authors.initials: G
authors.lastname: de Lamotte
authors.affiliation: Service de Santé Publique et d'Information Médicale , APHM, Hôpital Sainte-Marguerite , Marseille , France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Pradel
authors.affiliation: Direction Régionale du Service Médical du Régime Général de l'Assurance Maladie Paca Corse , Marseille , France.
authors.forename: François
authors.initials: F
authors.lastname: Natali
authors.affiliation: Direction Régionale du Service Médical du Régime Général de l'Assurance Maladie Paca Corse , Marseille , France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Allaria-Lapierre
authors.affiliation: Direction Régionale du Service Médical du Régime Général de l'Assurance Maladie Paca Corse , Marseille , France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Coudert
authors.affiliation: Service de Rhumatologie, APHM, Hôpital Sainte-Marguerite, Marseille, France; Faculté de Médecine, Aix-Marseille Université, Marseille, France.
authors.forename: Thao
authors.initials: T
authors.lastname: Pham
authors.affiliation: Direction Régionale du Service Médical du Régime Général de l'Assurance Maladie Paca Corse , Marseille , France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Sciortino
authors.affiliation: Service de Rhumatologie, APHM, Hôpital Sainte-Marguerite, Marseille, France; Faculté de Médecine, Aix-Marseille Université, Marseille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Lafforgue
keywords: Bone Mineral Density; Corticosteroids; Osteoporosis