Study Finds Management of Glucocorticoid-Induced Osteoporosis Is Even Worse Than Feared

Patients treated with glucocorticoids rarely receive the treatment recommended by the American College of Rheumatology guidelines needed to prevent and manage glucocorticoid-induced osteoporosis (GIOP), investigators reported at the annual meeting of the American College of Rheumatology in November.

Investigators analyzed the care received by veterans prescribed corticosteroids in Louisiana. Using the electronic database of the Department of Veterans Affairs Hospital in New Orleans, they identified all veterans who had filled systemic glucocorticoid (GC) prescriptions during a 2-year study period between January 1, 2016, and December 31, 2017.

A total of 1962 separate glucocorticoid prescriptions were filled during this 2-year period by 1051 unique patients, of which 206 patients were prescribed glucocorticoid for at least 90 days and were included in the study. Almost two thirds of the 206 patients (63%) were prescribed > 7.5 mg prednisolone-equivalent doses for more than 90 days.

The American College of Rheumatology recommends optimizing calcium intake at 1000–1200 mg/day and vitamin D intake at 600–800 IU/day in adults taking ≥ 2.5 mg prednisolone-equivalent doses for ≥ 3 months, but the researchers found that most patients in the study were not receiving vitamin D or calcium at the recommended doses.

Approximately half of the patients (52%) were prescribed Vitamin D supplementation with 80% of these prescribed the guideline-recommended dose. Just 26% of patients were prescribed calcium supplementation and only 44% of these were prescribed the guideline-recommended dose.

Fewer than one in 10 patients taking ≥ 7.5 mg for ≥ 3 months were on primary prophylaxis with anti-osteoporotic therapy. Bone mineral density testing was performed in 20% of patients, and 14% of the patients tested were found to have osteoporosis and 21% osteopenia.

As well as optimization of calcium and vitamin D intake, the American College of Rheumatology guidelines for the prevention and treatment of GIOP recommend initiation of oral bisphosphonates based on age, fracture risk, and glucocorticoid dose. It advises that an initial fracture risk assessment should be performed within 6 months of the initiation of long-term glucocorticoid treatment.

Eileen Rife, MD

Lead author Eileen Rife, MD, of Louisiana State University, said that the findings were “overall worse than previously published data."

“Glucose-induced osteoporosis remains an under-recognized and under-treated condition despite updated evidence-based practice guidelines,” she said. “Bone mineral density screening rates remain low, as do calcium/vitamin D supplementation and primary prophylaxis with anti-osteoporotic therapy.”

The poor performance may have been influenced by the profile of the study group. Osteoporosis is frequently associated with female patients, especially those who are postmenopausal.

Most of the patients included in the study were male (97%). A total of 51% were Caucasian and 46% were African American.

The results may also have been influenced by the providers treating the patients. Primary care providers were the main prescribers of long-term glucocorticoids for 51% of patients and rheumatologists were the main prescribers for 24% of patients.

Reference:

Rife E Nkechinyere E, and Leon de la Rocha J, et al. Glucocorticoid-induced osteoporosis: are we practicing prevention? Presented at: American College of Rheumatology Convergence 2020; November 5-9, 2020; Virtual. Accessed November 8, 2020. https://acrabstracts.org/abstract/glucocorticoid-induced-osteoporosis-are-we-practicing-prevention/