Prevention of glucocorticoid-induced osteoporosis - Experience in a managed care setting

Background: Treatment with glucocorticoids is the leading cause of drug-ind uced osteoporosis. Currently available guidelines indicate that patients re ceiving long-term glucocorticoid therapy should receive measures to prevent osteoporosis. Qbjectives: To examine whether patients receiving longterm glucocorticoid t herapy in a managed tare setting received preventive therapy or prescribed medications for osteoporosis and to identify patient and provider character istics associated with treatment. Subjects and Methods: A cohort of 224 health plan enrollees 20 years and ol der who were dispensed at least 1 oral glucocorticoid prescription per quar ter during the period October 1997 through September 1998 was identified fr om administrative data. Medical charts and administrative data were reviewe d to determine use of preventive therapy and prescribed medications for ost eoporosis. Resuls: Of the 224 patients, 62% had at least 1 documented intervention aim ed at osteoporosis prevention (counseling about calcium or vitamin D or wei ghtbearing exercise; prescription for estrogen, calcitonin, or bisphosphona te; or a bone mineral density study). Women were more likely than men to re ceive intervention (76% vs 44%; prevalence odds ratio, 4.41; 95% confidence interval, 2.17-9.10). Patients receiving a mean daily prednisone dose of 1 0 mg or more or 5 to less than 10 mg were no more likely to receive interve ntion than those receiving 5 mg or less prednisone daily. Sixty-two (90%) o f 69 patients who were prescribed glucocorticoid therapy by rheumatologists had at least 1 intervention documented compared with 29 (48%) of 60 for in ternists, 26 (55%) of 47 for pulmonologists, and 22 (46%) of 48 for all oth er physicians, In a multiple logistic regression model, including patient a ge, sex, mean daily glucocorticoid dose, and physician specialty, women and patients prescribed glucocorticoids by a rheumatologist were significantly more likely to receive intervention aimed at osteoporosis prevention. Conclusions: A substantial proportion of patients receiving long-term gluco corticoid therapy do not receive preventive therapy for osteoporosis. Effor ts should be made to reduce barriers to such treatment and increase the pro portion of patients given preventive therapy.