Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Glucocorticoid-induced osteoporosis (GIO) is the most common cause of secondary osteoporosis. Fracture related to GIO increases a patient’s mortality risk and reduces quality of life. The American College of Rheumatology (ACR) released updated guidelines on the prevention and treatment of GIO in 2010. For postmenopausal women (PMW) and men ≥50 years of age with past or anticipated oral glucocorticoid (GC) use of ≥90 days, treatment recommendations are stratified according to low (<10%), medium (10-20%) and high (>20%) 10-year risk of a major osteoporotic fracture calculated using the World Health Organization’s FRAX® fracture risk assessment tool, with recommendations taking into account dose and duration of therapy. We estimated the proportion of the US population currently taking oral GC from the National Health and Nutrition Examination Survey (NHANES) and calculated the proportion of the US population that should be treated for GIO according to the ACR guidelines.
Methods:
This study used 3 cycles between 2005 and 2010 of NHANES, a bi-annual US cross-sectional study designed to be representative of the entire non-institutionalized population. PMW aged ≥40 and men aged ≥50 with height and weight measurements who self-reported current use of an oral GC were included. FRAX® risk scores were calculated using NHANES risk factor data, and with femoral neck bone mineral density (BMD) when available. Anti-osteoporosis pharmaceutical treatment (AOP) was defined as reported use of a bisphosphonate, estrogen, raloxifene, or teriparatide. Results are presented as weighted percents (95% confidence interval) using interview weights and NHANES specific methodology for combining multiple cycles; population estimates are made from mid-year current population survey totals for 2005-2010.
Results:
An estimated 825,284 PMW in the US population used GC and met inclusion criteria, with mean age 64.8 (62.5, 67.1) years. GC were used by 1.66% (1.19, 2.14) of PMW; based on ACR GIO risk categories, 0.5% were low-risk (0.2, 0.7); 0.3% medium-risk (0.1, 0.5); and 0.9% high-risk (0.5, 1.2).
An estimated 683,784 men aged ≥50 in the US population used GC and met inclusion criteria, with mean age 66.0 (63.1-68.8) years. GC were used by 1.65% of the men; based on ACR GIO risk categories 0.6% were low-risk (0.3, 0.9); 0.6% medium-risk (0.3, 1.0); and 0.4% high-risk (0.2, 0.7).
Chronic GC use (≥90 days) was reported by 81.2% (69.2, 93.3) of PMW GC users, of whom 55.5% (40.7, 70.3) would be recommended AOP treatment by ACR guidelines. Chronic GC use was reported by 75.8% (63.2, 88.5) of men aged ≥50, of whom 51.8% (38.3, 65.3) would be recommended AOP treatment by ACR guidelines. Of those who met ACR criteria for treatment, only 13.8% (2.2, 25.4) of PMW and 5.0% (0.0, 11.5) of men aged ≥50 reported AOP use.
Conclusion:
Based on NHANES data, we estimate that greater than 1.5 million US PMW and men aged ≥50 were using an oral GC between 2005 and 2010. Using ACR guidelines, treatment would be recommended in greater than 50% of this population. However, less than 15% of PMW and 5% of men aged ≥50 reported use of an AOP medication. These results indicate a treatment gap in the management of GIO in the US.
Disclosure:
R. A. Overman,
None;
J. C. Toliver,
None;
J. Y. Yeh,
None;
M. L. Gourlay,
None;
C. L. Deal,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/proportion-of-u-s-older-adults-meeting-inclusion-criteria-for-2010-acr-recommendations-on-glucocorticoid-induced-osteoporosis/