OSTEOPOROSIS MANAGEMENT AMONG CHRONIC GLUCOCORTICOID USERS: A SYSTEMATIC REVIEW
Main Article Content
Keywords
Osteoporosis, glucocorticoids, practice patterns, systematic review
Abstract
Background
Clinical practice guidelines recommend that all patients starting chronic oral glucocorticoid ( GC ) therapy receive bone mineral density (BMD) testing and osteoporosis pharmacotherapy.
Objective
We completed a systematic review of observational studies to examine the proportion of patients on chronic oral GC therapy who receive osteoporosis management.
Methods
Two independent reviewers completed a systematic search of Ovid MEDLINE ® and EMBASE ® to identify all English language articles that examined the prevalence of osteoporosis management among chronic oral GC users. Clinical trials, abstracts, reviews, commentaries, and letters to the editor were excluded. Study methods and results ( use of BMD testing and osteoporosis pharmacotherapy) were abstracted and summarized by year and region.
Results
We identified 2 9 eligible studies published between 1999 and October 2013: 17 were conducted in North America, 5 in Europe, and 7 in other regions. Heterogeneity between patient populations and methods used to define chronic GC use precluded the direct comparison of results between regions, or overtime. Over 80% of studies identified that < 40% of chronic oral GC users received BMD testing or osteoporosis pharmacotherapy. When results of these studies were plotted by year, there was little evidence of improvement in osteoporosis management over time.
Conclusions
Despite consistent recommendations to target osteoporosis prevention at the onset of chronic oral GC therapy, osteoporosis is undermanaged among chronic oral GC users. Targeted interventions are needed to help reduce the burden of fracture-related morbidity associated with GC - induced osteoporosis.
References
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2. Diez - Perez A, Hooven FH, Adachi JD, et al. Regional differences in treatment for oste oporosis. The Global Longitudinal Study of Osteoporo sis in Women (GLOW). Bone 2011; 49:493 - 498 .
3. Donnan PT, Libby G, Boyter AC, Thompson P . The population risk of fractures attributable to oral corticosteroids. P harmacoepidemiol Drug Saf 2005; 14:177 - 186 .
4. Overman RA, Yeh JY, Deal CL . Prevalence of oral glucocorticoid usage in the United States: a general population perspe ctive. Arthritis Care Res 2013; 65:294 - 298 .
5. DiPiro JT, Talbert RL, Gary C , Yee PDF . Pharmacotherapy: A Pathophysiologic Approach. (20 08) McGraw - Hill Professional Publishing, http://edoqs.com/dipiro - pharmacotherapy - 7th - edition , Accessed 15 August 2013.
6. Papaioannou A, Morin S, Cheung AM, et al. 2010 clinical practice g uidelines for the diagnosis and management of osteoporosis in Canada: summary. Canadian Me dical Association Journal 2010; 182:1864 - 1873.
7. Kim HJ, Zhao H, Kitaura H, et al. Glucocorti coids and the osteoclast. Ann NY Acad Sci 2007; 335 - 339 .
8. Ito S, Suzuki N, Kato S, et al. Glucocorticoids induce the differentiation of a mesenchymal progenitor cell line, ROB - C26 into adipocytes and osteoblasts, but fail to induce terminal osteobl ast differentiation. Bone 2007; 40:84 - 92 .
9. Pereira RC, Delany AM, Canalis E . Ef fects of cortisol and bone morphogenetic protein - 2 on stromal cell differentiation: correlation with CCAAT - enhancer binding protein expression. Bone 2002; 30:685 - 691 .
10. Weinstein RS . Clinical practice. Glucocorticoid - induced b one disease. N Engl J Med 201 1; 365:62 - 70 .
11. LoCascio V, Bonucci E, Imbimbo B, et al. Bone loss in response to long - term glucocorticoid therapy. Bone and Mineral 1990; 8:39 - 51 .
12. van Staa TP, Leufkens HG, Abenhaim L, et al. Use of oral corticosteroids i n the United Kingdom. QJM 2000 ; 93:105 - 111 .
13. Zonana - Nacach A, Barr SG, Magder LS, Petri M . Damage in systemic lupus erythematosus and its association with cortico steroids. Arthritis Rheum 2000; 43:1801 - 1808 .
14. Lekamwasam S, Adachi JD, Agnusdei D, et al. An appendix to the 2012 IOF - E CTS guidelines for the management of glucocorticoid - induced oste oporosis. Arch Osteoporos 2012; 7:25 - 30 .
15. Grossman JM, Gordon R, Ranganath VK, et al. American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid - induced osteoporosis. Ar thritis Care Res 2010; 62:1515 - 1526 .
16. Recommendations for the prevention and treatment of glucocorticoid - induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Gu idelines. Arthritis Rheum 1996; 39:1791 - 1 801 .
17. Recommendations for the prevention and treatment of glucocorticoid - induced osteoporosis: 2001 update. American College of Rheumatology Ad Hoc Committee on Glucocorticoid - Induced Oste oporosis. Arthritis Rheum 2001; 44:1496 - 1503 .
18. Eastell R, Reid DM, Compston J, et al. A UK Consensus Group on management of glucocorticoid - induced osteoporosis : an update. J Intern Med 1998; 244:271 - 292 .
19. National Osteoporosis Society. Guidance on the prevention and management of corticosteroid induced osteoporosis. (1998) National Osteoporosis Society, Bath, UK
20. Bone and Tooth Society, National Osteoporosis Society, Royal College of Physicians. Glucocorticoid - induced Osteoporosis: Guidelines for Prevention and Treatment. (2002) Royal College of Physicians, London
21. Bernstein CN, Leslie WD, Leboff MS AGA technical review on osteoporosis in gastrointestinal d iseases. Gastroenterology 2003; 124:795 - 841 .
22. Hough S . Osteoporosis Clinical Guideline. South African Medical Association -- Osteoporosis W orking Group. S Afr Med J 2000; 90:907 - 944 .
23. Moher D, Liberati A, Tetzlaff J, Altman DG . Preferred reporting items for systematic reviews and meta - analyses: the PRISMA statement. BMJ 2009; 339:332 - 336 .
24. O'Donnell S, Cranney A, Wells GA, et al. Strontium ranelate for prev enting and treating postmenopausal osteoporosis. Cochrane Datab ase of Systematic Reviews 2006; Art. No.: CD005326:
25. Cranney A, Welch V, Adachi JD, et al. Calcitonin for the treatment and prevention of corticosteroid - induced osteoporosis. Cochrane Databa se Syst Rev Art No: CD001983 2000 .
26. Nielsen BR, Jorgensen NR, Schwarz P . Management of risk of glucocorticoid - induced osteoporosis due to systemic administration in general practice in Denmark. Eur J Gen Pract 2007; 13:168 - 171 .
27. Duyvendak M, Naunton M, van Roon EN, Brouwers JRBJ . Doctors' beliefs and knowledge on corticosteroid - induced osteoporosis: identifying barriers to improve prev ention. J Clin Pharm Ther 2011; 36:356 - 366 .
28. Soucy E, Bellamy N, Adachi JD, et al. A Canadian survey on the manageme nt of corticosteroid induced osteoporosis by rhe umatologists. J Rheumatol 2000; 27:1506 - 1512 .
29. Bell R, Carr A, Thompson P . Managing corticosteroid induced osteoporosis in medical outpatients. J R Coll Physicians Lond 1997; 31:158 - 161 .
30. Lekamwasam S . A hospital - based study of prophylactic therapy in glucocorticoid - induced o steoporosis. Ceylon Med J 2010; 55:44 - 46 .
31. Kirigaya D, Nakayama T, Ishizaki T, et al. Management and treatment of osteoporosis in patients receiving long - term glucocorticoid treatmen t: current status of adherence to clinical guidelines and re lated factors. Intern Med 2011; 50:2793 - 2800 .
32. Brask - Lindemann D, Eiken P, Eskildsen P, Abrahamsen B . Time trends for alendronate prescription practices in women with chronic obstructive pulmona ry disease and women exposed to systemic glucoc orticoids. Osteoporos Int 2013; 24:1891 - 1897 .
33. Paskins Z, Potter T, Erb N, et al. Audits of the prevention and treatment of corticosteroid - induced osteoporosis in outpatients with rheumatic diseases in th e W est Midlands. Clin Med 2006; 6:183 - 187 .
34. Peat ID, Healy S, Reid DM, Ralston SH . Steroid induced osteoporosis: an opportunity for prevention? Ann Rheum Dis 1995; 54:66 - 68 .
35. Walsh LJ, Wong CA, Pringle M, Tattersfield AE . Use of oral corticosteroids in the community and the prevention of secondary osteoporosis: a c ross sectional study. BMJ 1996; 313:344 - 346 .
36. Aagaard EM, Lin P, Modin GW, Lane NE . Prevention of glucocorticoid - induced osteoporosis: provider practice at an urban county hospital. Am J Med 1999; 107:456 - 460 .
37. Hart SR, Green B . Osteoporosis prophylaxis during corticosteroid treatment: failure to prescribe. Postgrad Med J 2002; 78:242 - 243 .
38. Ryan JG, Morgan RK, Lavin PJ, et al. Current management of corticost eroid - induced osteoporosis: variations in awareness and management. Ir J Med Sci 2004; 173:20 - 22 .
39. Curtis JR, Westfall AO, Allison J, et al. Agreement and validity of pharmacy data versus self - report for use of osteoporosis medications among chronic gluc ocorticoid users. P harmacoepidemiol Drug Saf 2006; 15:710 - 718 .
40. McKeown E, Bykerk VP, De Leon F, et al. Quality assurance study of the use of preventative therapies in glucocorticoid - induced osteoporosis in early inflammatory arthritis: results from the CATCH coho rt. Rheumatology (Oxford) 2012; 51:1662 - 1669 .
41. Gamez - Nava JI, Zavaleta - Muniz SA, Vazquez - Villegas ML, et al. Prescription for antiresorptive therapy in Mexican patients with rheumatoid arthritis: is it time to reevaluate the strategies for oste oporosis prevention? Rheumatol Int 2013; 33:145 - 150 .
42. Caplan L, Hines AE, Williams E, et al. An observational study of glucocorticoid - induced osteoporosis prophylaxis in a national cohort of male veterans with rheumatoid arthritis. Osteoporos Int 2011; 22 :305 - 315 .
43. Duyvendak M, Naunton M, Atthobari J, et al. Corticosteroid - induced osteoporosis prevention: Longitudinal practice patterns in The Netherlands 2001 - 2005. Osteoporos Int 2007; 18:1429 - 1433 .
44. Mohammad A, Ryan JG, Ralph N, et al. Improving tren ds in glucocorticoid - induced osteoporosis management: 2002 to 2006. Clin Exp Rheumatol 2007; 25:728 - 733 .
45. Blalock SJ, Norton LL, Patel RA, Dooley MA . Patient knowledge, beliefs, and behavior concerning the prevention and treatment of glucocorticoid - induc ed oste oporosis. Arthritis Rheum 2005; 53:732 - 739 .
46. Ungprasert S, Wangkaew S, Louthrenoo W . Physician's awareness of the prevention of corticosteroid induced osteo porosis. J Med Assoc Thai 2007; 90:59 - 64 .
47. Chantler IW, Davie MWJ, Evans SF, Rees JS . Ora l corticosteroid prescribing in women over 50, use of fracture prevention therapy, and bone densitomet ry service. Ann Rheum Dis 2003; 62:350 - 352 .
48. Shah SK, Gecys GT . Prednisone - induced osteoporosis: an overlooked and undertreated adverse eff ect. J Am Ost eopath Assoc 2006; 106:653 - 657 .
49. Elliott ME, Farrah RM, Binkley NC, et al. Management of glucocorticoid - induced osteoporosis in male v eterans. Ann Pharmacother 2000; 34:1380 - 1384 .
50. Osiri M, Saag KG, Ford AM, Moreland LW . Practice pattern variation among internal medicine specialists in the prevention of glucocorticoid - induced osteo porosis. J Clin Rheumatol 2000; 6:117 - 122 .
51. Buckley LM, Marquez M, Feezor R, et al. Prevention of corticosteroid - induced osteoporosis: result s of a patien t survey. Arthritis Rheum 1999; 42:1736 - 1739
52. Curtis JR, Westfall AO, Allison JJ, et al. Longitudinal patterns in the prevention of osteoporosis in glucocorticoid - treated patient s. Arthritis Rheum 2005; 52:2485 - 2494 .
53. Mudano A, Allison J, Hill J, et al. Variations in glucocorticoid induced osteoporosis prevention in a managed care coh ort. J Rheumatol 2001; 28:1298 - 1305 .
54. Ettinger B, Chidambaran P, Pressman A . Prevalence and determinants of osteoporosis drug prescription among patients wit h high exposure to glucocortico id drugs. Am J Manag Care 2001; 7:597 - 605 .
55. Che M, Ettinger B, Nguyen MT, et al. High - dose corticosteroid exposure and osteoporosis intervention in adults. A nn Allergy Asthma Immunol 2006; 97:497 - 501 .
56. Saag KG, Gehlbach S H, Curtis JR, et al. Trends in prevention of glucocorticoid - induced osteoporosis. J Rheumatol 2006 ; 33:1651 - 1657 .
57. Majumdar SR, Lix LM, Yogendran M, et al. Population - based trends in osteoporosis management after new initiations of long - term systemic glu cocorticoids (1998 - 2008) . J Clin Endocrinol Metab 2012; 97:1236 - 1242 .
58. Yood RA, Harrold LR, Fish L, et al. Prevention of glucocorticoid - induced osteoporosis: experience in a managed care setting. Arch Intern Med 2001; 161:1322 - 1327 .
59. Solomon DH, Katz J N, Jacobs JP, et al. Management of glucocorticoid - induced osteoporosis in patients with rheumatoid arthritis: Rates and predictors of care in an academic rheumatology practic e. Arthritis & Rheumatism 2002; 46:3136 - 3142 .
60. Feldstein AC, Elmer PJ, Nichols G A, Herson M . Practice patterns in patients at risk for glucocorticoid - induced osteoporosis. Osteopo ros Int 2005; 16:2168 - 2174 .
61. Cruse LM, Valeriano J, Vasey FB, Carter JD Prevalence of evaluation and treatment of glucocorticoid - induced osteoporosis in me n. J Clin Rheumatol 2006; 12:221 - 225 .
62. Liu RH, Albrecht J, Werth VP Cross - sectional study of bisphosphonate use in dermatology patients receiving long - term oral corticostero id therapy. Arch Dermatol 2006; 142:37 - 41
63. Guzman - Clark JRS, Fang MA, Sehl ME, et al. Barriers in the management of glucocorticoid - induced osteoporosi s. Arthritis Rheum 2007; 57:140 - 146
64. Ledwich LJ, Clarke K Screening and treatment of glucocorticoid - induced osteoporosis in rheumatoid arthritis patients in an urban multispecialty pr actice. J Clin Rheumatol 2009; 15:61 - 64
65. Thanou A, Ali T, Haq O, et al. Utilization of preventive measures for glucocorticoid - induced osteoporosis among veterans with inflammatory bowel disea se. ISRN Gastroenterology 2013; 2013: Article ID 862312 .
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