Prevalence and determinants of osteoporosis drug prescription among patients with high exposure to glucocorticoid drugs

Objective: To investigate use of osteoporosis drugs among patients with hig h exposure to glucocorticoid drugs. Study design: Retrospective review of pharmacy records. Methods: We identified patients aged greater than or equal to 20 years who received prescriptions for greater than or equal to2 g of prednisone (or eq uivalent) during any 12-month period between January 1, 1998, and December 31, 1999, and who initiated use of osteoporosis-specific drugs (alendronate sodium, etidronate disodium, and calcitonin) during that period. Results: Among 8807 patients who met study criteria, 772 (8.8%) received pr escriptions for osteoporosis drugs. Prevalence of osteoporosis drug prescri ptions increased linearly during the study and differed markedly by patient sex, age, and exposure to glucocorticoid drugs. Osteoporosis drugs were pr escribed for 16.3% of women aged greater than or equal to 65 years, for 6.1 % of women aged < 50 years, for 6.5% of men aged greater than or equal to 6 5 years, and for 2.2% of men aged < 50 years. Higher glucocorticoid exposur e was also associated with higher rate of osteoporosis drug prescription (1 1.2% of patients exposed to >4 g/y and 5.6% exposed to 2 to 3 g/y received such therapies). Osteoporosis drugs were 50% more likely to be prescribed b y clinicians who prescribed glucocorticoid drugs to > 18 patients than by p roviders who prescribed glucocorticoid drugs to <4 patients, Conclusions: Despite ready availability of bone-specific osteoporosis drugs , few patients with high exposure to glucocorticoid drugs received such the rapy. Likelihood of an osteoporosis drug being prescribed for such patients strongly depends on patient sex, age, and exposure to glucocorticoid drugs and on level of practitioner experience in prescribing glucocorticoid drug s.