Clinical Studies
Prevention of glucocorticoid-induced osteoporosis: provider practice at an urban county hospital☆

https://doi.org/10.1016/S0002-9343(99)00265-XGet rights and content

Abstract

Purpose: We sought to determine the frequency and types of prophylaxis for osteoporosis that were prescribed to outpatients who were receiving chronic glucocorticoid treatment and to identify the patient and provider characteristics that were associated with the use of prophylaxis.

SUBJECTS AND METHODS: We identified 215 adult outpatients at San Francisco General Hospital who had received a prescription for prednisone (or its equivalent) at a daily dose of at least 5 mg for at least 1 month. Patient demographic characteristics, the diagnosis for which glucocorticoids were prescribed, comorbid illnesses, and medications were determined by chart review. Characteristics of the patients who were prescribed prophylaxis were compared with those of patients who were not prescribed prophylaxis.

RESULTS: Prophylaxis for glucocorticoid-induced osteoporosis was prescribed to 58% of patients. Patients prescribed prophylaxis were older (mean [± SD] age of 50.0 ± 13.9 versus 44.5 ± 13.6 years, P = 0.004), more likely to be female (69% versus 40%, P <0.0001), postmenopausal if female (84% versus 56%, P = 0.002), have more comorbid illnesses (63% versus 29%, P = 0.001), and take multiple medications (66% versus 45%, P = 0.002). Patients attending the rheumatology clinic were 1.6 times more likely to receive prophylaxis than those attending other clinics (P <0.0001). The strongest predictor of prophylaxis was postmenopausal state. In premenopausal women, the independent predictors of prophylaxis were being treated in the rheumatology clinic and the presence of comorbid illnesses, whereas comorbid illnesses was the only independent predictor of prophylaxis in men.

CONCLUSIONS: Educational efforts should be directed toward increasing awareness of the importance of glucocorticoid-induced osteoporosis and its prevention.

Section snippets

Study subjects

The study was based in the outpatient clinics at San Francisco General Hospital and its nine affiliated community clinics, known as the San Francisco Community Health Network. Patients are generally economically disadvantaged (37% medically indigent, 12% Medicaid, 17% Medicare, 18% self-pay sliding scale, and 16% third-party insurance) and are ethnically diverse (30% white, 24% African American, 20% Latino, 20% Asian, 5% Filipino, and 1% Native American) (39).

San Francisco General Hospital has

Results

We identified 215 patients requiring glucocorticoids (87 men and 128 women). The mean (± SD) age of the patients was 47.7 ± 14.0 years, with a range of 21 to 82 years (Table 1). The patients were ethnically diverse. Thirty-seven percent of the patients were current smokers and 17% consumed alcohol regularly. Patients were most commonly prescribed glucocorticoids for rheumatic and pulmonary conditions. Patients were prescribed a mean dose of 19 ± 16 mg of prednisone (median 10 mg) for an average

Discussion

Only 58% of glucocorticoid-requiring patients received prophylaxis for osteoporosis. Two earlier studies performed in the United Kingdom 37, 38 found that only 5% to 14% of glucocorticoid-treated patients received prophylaxis for bone loss. Rates of prophylaxis were especially low among men and premenopausal women. Factors associated with the use of prophylaxis included having a rheumatic disease for postmenopausal women, receiving medical care in the rheumatology clinic for premenopausal

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    ☆

    Supported in part by Public Health Service Grant 1-R01–46661 to Dr. Lane, the Rosalind Russell Arthritis Research Center, and the Program in Osteoporosis and Bone Biology. The American College of Rheumatology Research and Education Foundation provided additional support.

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