Management of glucocorticoid-induced osteoporosis in male veterans

OBJECTIVE: To determine whether glucocorticoid-induced osteoporosis in male veterans was managed in accordance with American College of Rheumatology ( ACR) guidelines. These guidelines recommend bone mineral density (BMD) dete rmination at the initiation of long-term therapy with prednisone greater th an or equal to7.5 mg/d, provision of hormone replacement therapy as needed, calcium and vitamin D supplementation as necessary, and antiresorptive the rapy for low BMD. DESIGN: Patients receiving prednisone greater than or equal to7.5 mg/d thro ughout a predefined six-month period were identified through a hospital pha rmacy database. Electronic and paper chart review was carried out to determ ine whether BMD measurement by dual-energy X-ray absorptiometry had been pe rformed. Supplemental calcium and vitamin D intake was assessed for each pa tient. In addition, pharmacy records were reviewed to determine whether ant iresorptive therapy was prescribed for patients with low BMD. SETTING: The Wm. S. Middleton Veterans Affairs Medical Center, Madison, WI. RESULTS: Seventy-two men met study criteria. They had been receiving oral p rednisone treatment for a median of 30 months (range 6-74); mean daily dosa ge during the six-month study period was 12.5 mg (range 7.5-37.5). Extensiv e record review revealed that only six patients (8%) received recommended c alcium and vitamin D, and only 43 (60%) had a BMD determination. Of those 4 3 men, 32 had T-scores below -1, therefore meeting ACR criteria for recomme nded antiresorptive therapy. However, only 12 of these 62 patients were pre scribed antiresorptive therapy. Although this study was not designed to eva luate differences among clinics, there appeared to be better adherence to A CR guidelines for patients cared for in a rheumatology specialty clinic tha n in other clinics at the institution. CONCLUSIONS: Adherence to ACR guidelines for management of glucocorticoid-i nduced osteoporosis was poor. Efforts to improve the prevention and managem ent of glucocorticoid-induced osteoporosis in male veterans are warranted.