Oral corticosteroid prescribing in women over 50, use of fracture prevention therapy, and bone densitometry service

Chantler, Ingrid; Davie, M. W. J.; Evans, Sarah Helen; Rees, J S

doi:10.1136/ard.62.4.350

Cited by 25 publications

(15 citation statements)

References 16 publications

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“…However, similar to findings in our prior study and other US and international studies (11,12,(20)(21)(22)(23)(24), we found low utilization rates and significant practice pattern variation between physician specialties in screening and preventive therapies for glucocorticoid-induced osteoporosis. We also found significant variation between prescribing physician specialties in the proportion of their patients taking OTC calcium or vitamin D supplements.…”

Section: Temporal Trends In Prevention Of Glucocorticoid-induced Ostesupporting

confidence: 90%

Longitudinal patterns in the prevention of osteoporosis in glucocorticoid‐treated patients

Curtis¹,

Westfall²,

Allison³

et al. 2005

Arthritis & Rheumatism

136

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Objective. To evaluate patient and physician factors associated with prevention of glucocorticoidinduced osteoporosis and to describe temporal trends in screening and prevention of glucocorticoid-induced osteoporosis.Methods. Using databases from a national managed care organization, enrollees who had been prescribed glucocorticoids (taken for at least 60 days) during an 18-month period were identified. Administrative data from January Conclusion. Despite significant temporal increases in the frequency of screening for and treatment of glucocorticoid-induced osteoporosis, absolute rates remain low, especially among men, African Americans, and patients of certain physician specialties.Glucocorticoids are prescribed widely in medical practice and are used by 0.5-2.5% of adults (1,2). Despite the acknowledged benefits of glucocorticoid treatment in controlling short-term inflammation, concerns about associated adverse events often limit its use. Among the most feared is glucocorticoid-induced osteoporosis. Rates of glucocorticoid-induced osteoporosisassociated fracture may approach 40% in selected populations (3,4), and this condition often results in

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Section: Temporal Trends In Prevention Of Glucocorticoid-induced Ostesupporting

confidence: 90%

Longitudinal patterns in the prevention of osteoporosis in glucocorticoid‐treated patients

Curtis¹,

Westfall²,

Allison³

et al. 2005

Arthritis & Rheumatism

136

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“…For example, among patients with early rheumatoid arthritis, combination therapy that includes glucocorticoids may have a sustained, disease‐modifying effect (30). However, minimizing potentially avoidable AEs such as glucocorticoid‐induced osteoporosis, for which there are efficacious but underutilized therapies (31–34), must be a shared responsibility among physicians and patients. Despite advances in chronic disease management, it is unlikely that the long‐term use of glucocorticoids will disappear any time soon.…”

Section: Discussionmentioning

confidence: 99%

Population‐based assessment of adverse events associated with long‐term glucocorticoid use

Curtis

Westfall

Allison

et al. 2006

Arthritis & Rheumatism

476

305

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Objective. The frequency of many adverse events (AEs) associated with low-dose glucocorticoid use is unclear. We sought to determine the prevalence of glucocorticoid-associated AEs in a large US managed care population. Methods. Using linked administrative and pharmacy claims, adults receiving >60 days of glucocorticoids were identified. These individuals were surveyed about glucocorticoid use and symptoms of 8 AEs commonly attributed to glucocorticoid use. Results. Of the 6,517 eligible glucocorticoid users identified, 2,446 (38%) returned the mailed survey. Respondents were 29% men with a mean ؎ SD age of 53 ؎ 14 years; 79% were white and 13% were African American. Respondents had a mean ؎ SD of 7 ؎ 3 comorbid conditions and were prescribed a mean ؎ SD prednisone-equivalent dosage of 16 ؎ 14 mg/day. More than 90% of individuals reported at least 1 AE associated with glucocorticoid use; 55% reported that at least 1 AE was very bothersome. Weight gain was the most common self-reported AE (70% of the individuals), cataracts (15%) and fractures (12%) were among the most serious. After multivariable adjustment, all AEs demonstrated a strong dose-dependent association with cumulative glucocorticoid use. Among users of low-dose therapy (<7.5 mg of prednisone per day), increasing duration of use was significantly associated with acne, skin bruising, weight gain, and cataracts. Conclusion. The prevalence of 8 commonly attributed self-reported glucocorticoid-associated AEs was significantly associated with cumulative and average glucocorticoid dose in a dose-dependent fashion. Physicians should be vigilant for glucocorticoid-related AEs and should counsel patients about possible risks, even among low-dose long-term users.

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“…Despite the effectiveness of the above medications for prevention and treatment of GIOP, only a small proportion of patients treated with chronic glucocorticoids receive treatment 45–48 . Despite newer guidelines and broader use of electronic health records, GIOP remains under-recognized and under-treated 49 .…”

Section: Improving Care Of Patients At Risk Of Glucocorticoid Inducedmentioning

confidence: 99%

Prevention and Treatment of Bone Changes Associated with Exposure to Glucocorticoids

Warriner

2013

Curr Osteoporos Rep

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Rheumatologic diseases are associated with a pro-inflammatory state which is thought to lead to many of the bone changes seen in treatment-naive patients. However, glucocorticoids remain a common treatment option for rheumatologic diseases and are known to have a negative impact on bone through direct effects on bone cells and indirect effects on calcium absorption. Despite the anti-inflammatory effect of glucocorticoids, fracture risk rises within the first three months of treatment. As such, osteoporosis prevention and treatment need to be considered in all patients started on chronic glucocorticoids (≥3 months of treatment). For very low risk patients, conservative management with non-pharmacologic strategies may be appropriate. For the moderate to high fracture risk patients treated with glucocorticoids, pharmacologic treatment with one of the four approved medications should be considered. The challenge of educating physicians and patients of the risks of glucocorticoid induced osteoporosis remain.

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Oral corticosteroid prescribing in women over 50, use of fracture prevention therapy, and bone densitometry service

Cited by 25 publications

References 16 publications

Longitudinal patterns in the prevention of osteoporosis in glucocorticoid‐treated patients

Longitudinal patterns in the prevention of osteoporosis in glucocorticoid‐treated patients

Population‐based assessment of adverse events associated with long‐term glucocorticoid use

Prevention and Treatment of Bone Changes Associated with Exposure to Glucocorticoids

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