Population-Based Trends in Osteoporosis Management after New Initiations of Long-Term Systemic Glucocorticoids (1998–2008)

• Published in: The journal of clinical endocrinology and metabolism 2012-04, Vol.97 (4), p.1236-1242
• Main Authors: Majumdar, S. R, Lix, L. M, Yogendran, M, Morin, S. N, Metge, C. J, Leslie, W. D
• Format: Article
• Language: English
• Subjects: Adult; Age; Age Factors; Aged; Aged, 80 and over; Biological and medical sciences; Bone Density; Bone Density Conservation Agents - therapeutic use; Bone mineral density; Cohort Studies; Drug Monitoring; Drug Prescriptions; Endocrinopathies; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; General Practitioners; Glucocorticoids; Glucocorticoids - adverse effects; Humans; Male; Manitoba - epidemiology; Medical Record Linkage; Medical sciences; Middle Aged; Osteoporosis; Osteoporosis - chemically induced; Osteoporosis - drug therapy; Osteoporosis - prevention & control; Poisson Distribution; Population studies; Practice Guidelines as Topic; Practice Patterns, Physicians' - trends; Prednisone; Registries; Regression analysis; Sex; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Young Adult
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2011-2645

Objectives: Our objective was to describe changes in glucocorticoid-induced osteoporosis (GIOP) preventive care from 1998–2008 including rates and correlates of bone mineral density (BMD) testing and osteoporosis treatment in new long-term glucocorticoid initiations. Methods: A population-based study of adults aged 20 yr or older in Manitoba, Canada, was conducted using linked healthcare databases. Subjects with new long-term (≥90 d) systemic glucocorticoid initiations were identified within each fiscal year. High-quality GIOP preventive care was defined by the composite of BMD testing or osteoporosis treatment within 6 months of starting glucocorticoids. For each initiation, we identified sociodemographic and clinical characteristics, prednisone dose equivalents, and prescriber specialty. Multivariable Poisson regression models were used to calculate adjusted incidence rate ratios (aIRR). Results: We studied 17,736 new long-term glucocorticoid initiations; one third were at least 10 mg prednisone daily, and most (64%) were prescribed by general practitioners. Overall, 6-month rates of BMD testing were 6%, osteoporosis treatment 22%, and the composite of testing or treatment 25%. From 1998–2008, there were modest increases in BMD testing (from 4 to 6%), osteoporosis treatment (from 15 to 24%), and testing or treatment [from 17 to 27%; aIRR = 1.51; 95% confidence interval (CI) = 1.40–1.63]. High-quality GIOP preventive care varied significantly by age (16% for those