Background/Purpose: Glucocorticoid-induced osteoporosis (GIOP) is a well-established and well-studied phenomenon that is a sequela of the treatment of many inflammatory diseases. Many studies over the years have looked at compliance with guidelines for the prevention and treatment of GIOP. Previous studies have shown compliance with recommendations to be quite poor in regards to DXA screening, as well as calcium and vitamin D supplementation. This study aimed to give a current look at this issue, particularly in light of the most recent release of ACR GIOP guidelines in 2017, to see if compliance has improved over the years.

Methods: Patients who had received a prescription of prednisone between July 2016 to July 2017 from the VA Connecticut Health System were identified. The first 300 patient’s charts were reviewed. Patients were excluded if they had received one time tapers of prednisone or if they were receiving prednisone for malignancy and were since deceased. Subsequently 266 patients were included for analysis (on prednisone for ≥3 months, dose ≥2.5mg daily, and any indication). Data on age, last dosage of prednisone, duration of treatment, diagnosis, DXA status, DXA results, vitamin D levels, and whether patients were on calcium or vitamin D supplementation were collected.

Results: Of 266 patients included for analysis, mean age was 71 (standard deviation 12 years), mean dosage 7.65mg (range 1-50mg). 120 patients had undergone DXA examination (45.1%), 146 had not. The most frequent diagnoses’ were RA with 49 patients, COPD 40, PMR 37, transplant 23, and myasthenia gravis 13. Prescriber specialty 114 patients rheumatology, 50 primary care physician, 24 pulmonary, 19 nephrology, 15 each hematology-oncology and neurology, 29 other. Rheumatologists had a rate of DXA scans of 53.5%, primary care physicians 38%, pulmonary 29.2%, renal 42.1%, hematology-oncology 33.3%, and neurology 46.67%. Taking into consideration the 2017 guidelines, with patients ≥40 years of age, 45.9% of appropriate patients underwent DXA, 54% did not. Per 2017 guidelines 51.7% were appropriately on calcium supplementation and 57.5% appropriately on vitamin D supplementation.

Conclusion: There have been many studies over the years regarding compliance with guidelines for GIOP. In this particular study, as seen previously, we show poor compliance with only 45.1% of patients appropriately undergoing DXA screening. If accounting for the 2017 guidelines in the cohort of patients ≥40 years of age this improves to 45.9%. Patients are still largely not undergoing proper screening and even when they do a large proportion, 48.3% for calcium, 42.4% for vitamin D are not receiving the appropriate calcium and vitamin D supplementation. With each new iteration of guidelines for GIOP it becomes imperative to adjust practice habits appropriately. Unfortunately study after study shows this is not occurring. Given the continued poor compliance on the part of providers it is worth considering a reduction in frequency of revision of guidelines and better provider education to finally lead to improved compliance.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/compliance-with-screening-and-supplementation-guidelines-for-glucocorticoid-induced-osteoporosis-how-bad-did-we-do-this-time/