Compliance with Guidelines Could Reduce Fracture Risk

Newswise — Despite the availability of medications to decrease the fracture risk that comes with long-term treatment with corticosteroid medications like prednisone, fracture risk remains elevated for patients taking corticosteroids, suggesting that preventive medicines and treatments are underused by health care providers, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Orlando, Florida.

The study examined outpatient pharmacy files of 203,170 veterans in the Veterans Integrated Service Network and identified 16,143 patients who had been prescribed oral corticosteroids. In a sample of manually reviewed charts, the researchers found that approximately one-third of those patients also received treatment to prevent bone loss and osteoporosis. Fractures were 30% higher in patients taking prednisone for at least three months of any year during the four-year study, than for patients who never took prednisone.

The ACR published updated guidelines to assist health care providers in identifying and managing patients at risk for corticosteroid induced osteoporosis in 2001. Corticosteroid treatment is associated with significant side effects, of which bone loss that leads to osteoporosis and higher fracture risk is the most serious. The guidelines recommend measures to identify and treat at-risk patients, including bone mineral density testing to measure bone strength, and preventive therapies including supplemental calcium and vitamin D, and bisphosphonate medications if necessary.

"Our research findings are in agreement with several other studies, demonstrating that there is a broader need for improvement of compliance with preventive guidelines when starting a patient on glucocorticoids. This problem transcends the scope of practice of rheumatologists since glucocorticoids are widely prescribed by allergists, pulmonologists, hematologists, nephrologists, neurologists, primary care providers and other medical providers," said Antonio A. Lazzari, MD, FACR, of the VA Boston Healthcare System, and lead investigator in the study. "After establishing a pioneer osteoporosis prevention clinic at the VA Boston Health Care System and performing an educational intervention with providers prescribing glucocorticoids, we have noticed an increased level of awareness and compliance to preventive guidelines which could reduce the risk of developing glucocorticoid-induced osteoporosis and consequently the fracture risk."

The American College of Rheumatology is the professional organization for rheumatologists and health professionals who share a dedication to healing, preventing disability and curing arthritis and related rheumatic and musculoskeletal diseases. For more information on the ACR's annual meeting, see http://www.rheumatology.org/annual.