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.