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Few doctors take measures to prevent bone loss and related fractures among people on long-term steroid therapy

Medications called glucocorticoids (e.g., prednisone) are used to treat a million or more Americans each year for chronic rheumatic, pulmonary, gastrointestinal, and skin diseases, as well as in organ transplantation. Unfortunately, chronic users of glucocorticoids are at risk for glucocorticoid-induced osteoporosis (GIOP) and have an estimated 50 percent fracture risk. Guidelines recommend that people who require more than 3 months of this therapy take measures to prevent bone loss, such as calcium supplements, vitamin D, estrogen (for postmenopausal women), and antiresorptive medications and undergo periodic measurements of bone mineral density.

According to a recent study supported in part by the Agency for Healthcare Research and Quality (HS10389), few doctors prescribe GIOP prevention therapy for patients taking glucocorticoids. Over the 3-year study period, researchers at the University of Alabama, Birmingham's Center for Education and Research on Therapeutics identified 2,378 members of a large national health maintenance organization who were receiving long-term glucocorticoid therapy to determine whether they underwent bone mass measurements or were prescribed medications to prevent osteoporosis. Internal medicine specialists (39 percent), general/family practitioners (16 percent), and rheumatologists (16 percent) wrote the majority of prescriptions for glucocorticoids.

Only 21 percent of all patients receiving glucocorticoids for a chronic condition received some form of prescription treatment for osteoporosis during the study period. For women age 50 and over, the group at greater risk for fractures, only 41 percent received osteoporosis preventive therapies. However, this was mostly estrogen, and only 6 percent of estrogen prescriptions were made after initiation of glucocorticoid therapy. Only 16 percent of women age 50 and over and less than 10 percent of all patients received a bone mass measurement. Patients of rheumatologists were twice as likely as those of internists to have a bone mass measurement and to receive bisphosphonates, but they were not more likely to receive preventive treatment overall.

Details are in "Variations in glucocorticoid induced osteoporosis prevention in a managed care cohort," by Amy Mudano, M.P.H., Jeroan Allison, M.D., M.Sc., Jerrold Hill, Ph.D., Todd Rothermel, and Kenneth Saag, M.D., M.S., in the June 2001 Journal of Rheumatology 28(6), pp. 1298-1305.

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