VARIATIONS IN PHYSICIANS JUDGMENTS ABOUT CORTICOSTEROID-INDUCED OSTEOPOROSIS BY PHYSICIAN SPECIALTY

Objective. Longterm corticosteroid use is associated with an increased risk of osteoporosis and fractures. Calcium and vitamin D supplementa tion and estrogen replacement therapy can decrease this risk, but the majority of patients receiving longterm corticosteroid treatment do no t receive treatments to prevent bone loss. We assess whether this is d ue to variations in physicians' judgments about risks and efficacy of treatments to prevent corticosteroid-induced osteoporosis. Methods. Qu estionnaires were mailed to 425 physicians, who were sampled so that h alf were generalists and half were specialists. Physicians were given hypothetical clinical scenarios involving patients taking corticostero ids and asked to judge the importance of osteoporosis as a risk of cor ticosteroid treatment, the importance of discussing this side effect w ith patients, and to indicate how often they would use calcium with vi tamin D and estrogen for a hypothetical postmenopausal patient receivi ng longterm corticosteroid treatment. Results. In total 198 physicians (50%) responded to this survey. Most physicians rated osteoporosis as one of the 3 most significant side effects of corticosteroid treatmen t for postmenopausal women, but there was significant variation in phy sician judgments about the importance of corticosteroid induced osteop orosis for premenopausal women (p = 0.03) and men (p = 0.001), There w as also significant variation in physician judgments about the importa nce of discussing osteoporosis as a side effect with patients (p = 0.0 01), and their use of both calcium and vitamin D (p = 0.002) and estro gen replacement therapy (p = 0.001) for a hypothetical postmenopausal patient. The physician characteristics most associated with these diff erences were physician specialty and experience with corticosteroid us e. Primary care physicians and physicians who more commonly prescribe corticosteroids were more likely to report that they would use estroge n and calcium to prevent corticosteroid induced bone loss. Physician a ge, sex, and university affiliation had no association with physician assessments. Conclusion. Physicians' judgments varied significantly by physician specialty and experience with corticosteroid use. These dat a suggest that patients cared for by physicians in different specialti es will get varying advice about osteoporosis risk and preventive trea tments when receiving longterm corticosteroid treatment.