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Original article
Osteoporosis prevention among chronic glucocorticoid users: results from a public health insurance database
  1. Sophie Trijau1,
  2. Gaëlle de Lamotte1,2,
  3. Vincent Pradel3,
  4. François Natali4,
  5. Véronique Allaria-Lapierre4,
  6. Hervé Coudert4,
  7. Thao Pham1,2,
  8. Vincent Sciortino4 and
  9. Pierre Lafforgue1,2
  1. 1Service de Rhumatologie, APHM, Hôpital Sainte-Marguerite, Marseille, France
  2. 2Faculté de Médecine, Aix-Marseille Université, Marseille, France
  3. 3Service de Santé Publique et d'Information Médicale, APHM, Hôpital Sainte-Marguerite, Marseille, France
  4. 4Direction Régionale du Service Médical du Régime Général de l'Assurance Maladie Paca Corse, Marseille, France
  1. Correspondence to Professor Pierre Lafforgue; pierre.lafforgue{at}ap-hm.fr

Abstract

Introduction Long-term glucocorticoid therapy is the leading cause of secondary osteoporosis. The management of glucocorticoid-induced osteoporosis (GIOP) seems to be inadequate in many European countries.

Objective To evaluate the rate of screening and treatment of GIOP.

Design Information was collected from a national public health-insurance database in our geographic area of Provence-Alpes-Côte-d'Azur and in Corsica, from September 2009 through August 2011.

Patients We identified participants aged 15 years and over starting glucocorticoid therapy (≥7.5 mg of prednisone equivalent per day during at least 90 days consecutive). This cohort was compared with an age-matched and sex-matched population that did not receive glucocorticoids.

Main outcome measures Bone mass, prescription of bone antiresorptive medication and use of calcium and/or vitamin D treatment.

Results We identified 32 812 patients who were prescribed glucocorticoid therapy, yielding 1% prevalence. Incidence of glucocorticoid therapy was 2.8/1000 inhabitants/year. Males represented 44%, the mean age was 58 years. The median prednisone-equivalent dose was 11 mg/day (IQR 9–18 mg/day). 8% underwent bone mass measurement. Calcium and/or vitamin D, and bisphosphonates were prescribed in 18% and 12%, respectively. Results were lower for the control population: 3% underwent bone mass measurement and 3% received bisphosphonate therapy. The rates of osteodensitometry and treatments were higher in women over 55 years of age than in men and women 55 years of age and younger, and also when glucocorticoid therapy was initiated by a rheumatologist versus other physician specialty.

Conclusions The management of GIOP remains very inadequate, despite the availability of a statutory health insurance system. Targeted interventions are needed to improve the management of GIOP.

  • Osteoporosis
  • Corticosteroids
  • Bone Mineral Density

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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