Glucocorticoid-Induced Osteoporosis: Are We Practicing Prevention?

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SN Comprehensive Clinical Medicine


The objective of the study is to describe healthcare provider adherence with current guidelines for the management of patients at risk for glucocorticoid induced osteoporosis. This is a descriptive study. We queried the electronic database of the Department of Veterans Affairs Hospital in New Orleans and collected data on all veterans who filled systemic glucocorticoid (GC) prescriptions during a 2-year study period (January 1, 2018 to December 31, 2019). A total of 1,962 separate GC prescriptions were filled, and 1051 unique patients identified. Of those, 206 patients were prescribed GC for ≥ 90 days and comprised our study population. There was a male predominance, with 51% self-identifying as Caucasian and 46% as African American. A majority (68%) of prescriptions were for less than 10 mg prednisolone-equivalent doses per day (PED). Primary care providers were the main prescribers of long-term GC (51%, n = 105), followed by rheumatologists (24%, n = 49). BMD testing was performed in 20% of patients (n = 42). Of those tested, 14% were found to have osteoporosis, and 21% had osteopenia. Approximately half of our study population were prescribed vitamin D supplementation with 80% prescribed the guideline-recommended dose. Twenty-six percent of patients were prescribed supplemental calcium, with 44% prescribed the guideline-recommended dose. Out of the 206, 130 (63%) of the study population were on long-term and high-dose PED (> 7.5 mg/day). Of those, less than 10% were on primary prophylaxis with an anti-osteoporotic agent. GIOP remains an under-recognized and under-treated condition despite evidence-based practice guidelines. Our findings are overall worse than previously published data.