Background/Purpose: Descriptive study designed to assess compliance to evidence-based practice guidelines for the prevention of Glucocorticoid-Induced Osteoporosis (GIOP).

Methods: We queried the electronic database of the Department of Veterans Affairs Hospital in New Orleans and collected data on all veterans who filled systemic glucocorticoid (GC) prescriptions during a 2-year study period (January 1, 2016 – December 31, 2017). Data was collected on GC dosage and duration of therapy – with long term GC therapy defined as continuous treatment for ≥3 months (90 days).  Data was also collected on demographics, specialty of the ordering prescriber, bone mineral density (BMD) testing, prescriptions for anti-osteoporotic therapy, and prescriptions for Vitamin D and/or Calcium supplementation. The recommendations followed were in accordance with the American College of Rheumatology, American Geriatrics Society, Institute of Medicine, and National Osteoporosis Foundation guidelines.

Results: During our study period, a total of 1,962 separate GC prescriptions were filled. Of those, 1,051 unique patients were identified. A total of 206 patients were prescribed GC for ≥90 days during the study window and they comprised our study population. Patients were predominately male (97%); 51% self-identified as Caucasian, and 46% as African American. A majority (68%) of prescriptions were for less than 10mg prednisolone-equivalent doses.  Most prescriptions (63% n=130) were for >7.5mg prednisolone-equivalent doses for greater than 90 days.  Primary care providers were the main prescribers of long-term GC (51%, n=105), followed by rheumatologists (24%, n=49). BMD testing was performed in 20% of patients (n=42). Of those tested, 14% (n=6) were found to have osteoporosis and 21% (n=9) had osteopenia. Approximately half of our study population (52%) were prescribed Vitamin D supplementation with 80% prescribed the guideline-recommended dose. Twenty-six percent of patients were prescribed supplemental Calcium, with 44% prescribed the guideline-recommended dose. Fewer than 10% of the patients taking greater than 7.5mg for ≥3 months (and meeting ACR treatment guidelines) were on primary prophylaxis with anti-osteoporotic therapy.

Conclusion: Our findings are overall worsethan previously published data. GIOP remains an under recognized and undertreated condition despite updated evidence-based practice guidelines. Bone mineral density screening rates remain low, as do Calcium/Vitamin D supplementation and primary prophylaxis with anti-osteoporotic therapy.

« Back to ACR Convergence 2020

ACR Meeting Abstracts - https://acrabstracts.org/abstract/glucocorticoid-induced-osteoporosis-are-we-practicing-prevention/