Background/Purpose: Glucocorticoids (GC) are used as a long-term treatment option for an estimated 1% of the US population. The American College of Rheumatology has maintained guidelines to aid in the prevention and treatment of glucocorticoid-induced osteoporosis (GIOP). These recommendations include optimization of calcium and vitamin D intake and initiation of oral bisphosphonates based on age, fracture risk, and GC dose. The purpose of this study was to evaluate whether patients at the Rheumatology Clinic of Froedtert & the Medical College of Wisconsin’s Froedtert Hospital who were prescribed chronic high-dose prednisone ( > 7.5mg/day for ≥ 3 months) for a rheumatologic disease underwent a comprehensive assessment for GIOP.

Methods: This was a retrospective quality improvement study of 61 patients aged 40 to 90 years who were prescribed chronic high-dose prednisone by Froedtert Hospital Rheumatology Clinic providers between January 1, 2017 and December 31, 2017. The primary outcome was the percentage of patients who had a comprehensive assessment for GIOP, defined as assessment of calcium, vitamin D, dual-energy x-ray absorptiometry (DXA), and Fracture Risk Assessment Tool (FRAX™). Secondary outcomes included the percentage of patients with osteoporotic and non-osteoporotic fractures during the follow-up period; the percentage of patients starting an osteoporosis medication during the follow-up period; new osteopenia or osteoporosis diagnosis during the follow-up period; assessment of calcium, vitamin D, DXA and FRAX as individual measures; presence of calcium supplementation on the medication list; and appropriate vitamin D treatment.

Results: A comprehensive GIOP assessment including calcium, vitamin D, DXA imaging, and FRAX calculation was completed in 7% of the study population. Approximately 21% of patients had 0 factors assessed, 39% had one factor assessed, 16% had two factors assessed, and 16% had three factors assessed. The lowest rates were with FRAX calculation at 11% and DXA imaging at 26%.  During the follow-up period, 8% of patients developed a new fracture, 8.5% were diagnosed with osteopenia or osteoporosis, and 14.9% were started on a new osteoporosis medication. The statistically significant results within the subgroup analyses included a higher rate of:  calcium supplementation on the medication list (79% vs 32%, p=0.004) in patients with baseline diagnosis of osteoporosis; number of individual components of GIOP assessment completed (p=0.049) and DXA (33% vs 0%, p=0.026) in patients ≥ 50 years of age; comprehensive GIOP assessment (25% vs 2%, p=0.022), number of individual components (p=0.003), and FRAX (42% vs 4%, p=0.002) in patients who met with rheumatology clinic pharmacist; and number of individual components (p< 0.001), calcium assessment (77% vs 44%, p=0.016), and vitamin D level assessment (77% vs 41%, p=0.008) in patients taking very high-dose prednisone.

Conclusion: A comprehensive GIOP assessment was not routinely completed when patients were initiated on a high-dose GC. When evaluating the individual components of the assessment, DXA and FRAX were not completed as regularly as calcium and vitamin D assessments.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessment-and-treatment-of-glucocorticoid-induced-osteoporosis-in-a-rheumatology-clinic/