Fewer than 50% of women and 25% of men taking chronic oral steroids undergo screening or receive treatment for glucocorticoid-induced osteoporosis (GIOP), according to an analysis of a large managed-care database between 2001 and 2003.
Rates of screening and treatment for glucocorticoid-induced osteoporosis have improved since a similar assessment review five years earlier, but the management of the associated with GIOP remains far below optimal, reported Jeffrey Curtis, MD, the lead investigator from the University of Alabama in Birmingham who reviewed the patient data.
"This leads us to challenges and opportunities for improvement," Dr. Curtis said at the annual meeting of The American Society for Bone and Mineral Research in Seattle. "Evidence suggests that early and rapid bone loss occurs with the initiation of glucocorticoid therapy. New users need to be highlighted as being at particular risk. African Americans and men also are at increased risk compared to non-users."
The findings emerged from a review of medical records for 6517 patients who took glucocorticoids for at least 60 days during 2001-2003. The patients were identified from the database of a managed care company covering more than 3 million people across 36 states.
With respect to screening for osteoporosis, the analysis showed that only 20% of men had received some form of measurement for bone mineral density (BMD), though considerably higher than the 5% reported in the 1995-98 review, noted Dr. Curtis, an internist and epidemiologist at the University of Alabama in Birmingham.
By contrast, 34% of women younger than 50 years of age and 46% of older women who had received glucocorticoids over the two-month period had been screened for osteoporosis, higher than the 7% and 16%, respectively, observed during the earlier review period, he said.
The records were evaluated for evidence of a BMD assessment and use of medications to treat osteoporosis, Dr. Curtis reported, and the findings were compared with data from an earlier study covering 1995 to 1998.
The 6517 patients included 5641 who initiated glucocorticoid therapy during the review period. The mean age of the patients was 50 years, with a daily steroid dose of 16 mg prednisone (or equivalent dosage of a comparator steroid).
The patient population was fairly ill, as reflected by the presence of an average of seven co-morbidities. Surveys returned by 2300 of the patients showed that 40% were not taking calcium or vitamin D supplements.
The review of the managed-care database found that 23% of men, 33% of the younger women, and 62% of the older women had used a hormonal agent or other bone protective medications. Theses figures, according to Dr. Curtis, represented absolute improvement of about 15% to 20% for each age group from the figures reported in 1995-1998.
Bisphosphonate therapy was documented in 15% of men, 16% of women younger than 50, and 31% of women aged 50 and older. The rates represented two- to fourfold improvement over the earlier review period.
Dr. Curtis reported that rheumatologists were more likely than family physicians to order bone mineral measurements for their patients on chronic glucocorticoid therapy, while family and general physicians were less likely than internists to request any type tool to measure BMD.
With respect to bisphosphonate therapy, pulmonologists were more likely than gastroenterologists to write prescriptions for bisphosphonates. Otherwise, medication use was similar.
Of note, African Americans and other minorities were less likely to be screened or to receive medication for GIOP.
Dr. Curtis said the results are cause for concern, given that national and international guidelines exist for management of GIOP in patients on chronic oral steroid therapy.
References
Curtis JR, et al. Screening and treatment of glucocorticoid induced osteoporosis among 6,517 adults. J Bone Miner Res. 2004;19(suppl 1):S30. Abstract 1114.