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An observational study of glucocorticoid-induced osteoporosis prophylaxis in a national cohort of male veterans with rheumatoid arthritis

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Abstract

Summary

We applied regression techniques to a large cohort of patients to understand why certain patients are prescribed medications to prevent glucocorticoid-induced osteoporosis (GIO). Rates of prescriptions to prevent osteoporosis were low. The presence of drugs and disorders associated with osteoporosis and gastrointestinal conditions actually are associated with a decreased likelihood of receiving osteoporosis-preventing medications.

Introduction

To understand why some patients are prescribed medications to prevent GIO while other patients are not, we examined whether there is an association among osteoporosis-inducing medical conditions or medications and prescriptions for osteoporosis prophylaxis in a large cohort of rheumatoid arthritis patients on chronic glucocorticoids.

Methods

Department of Veterans’ Affairs national administrative databases were used to construct a cohort (n = 9,605) and provide the data for this study. Multivariate logistic regression was performed to determine medical conditions and medications associated with dispensing of GIO-preventive medications, controlling for sociodemographic variables, comorbidities, glucocorticoid dosage, prior fractures, and rheumatoid arthritis severity. A subanalysis examined predictors of early GIO prevention.

Results

Subjects were more likely to receive GIO prophylaxis if they were older, African American, treated with multiple antirheumatic disease-modifying drugs, or received greater glucocorticoid exposure. The prescription of certain drug classes (loop diuretics and anticonvulsants) and conditions (malignancy, renal insufficiency, alcohol abuse, and hepatic disease) were associated with lower likelihood of GIO prophylaxis, despite putative links between these agents/conditions and osteoporosis. The presence of gastrointestinal disorders dramatically decreased likelihood of GIO prophylaxis. Few characteristics predicted the dispensing of GIO-preventing medications within 7 days of the initial glucocorticoid start date.

Conclusions

Rates of prescriptions to prevent osteoporosis in a cohort of older men with rheumatoid arthritis on chronic glucocorticoids were low. Gastrointestinal disorders and drugs and disorders potentially linked to osteoporosis are associated with diminished odds of being prescribed GIO-preventing medications.

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Acknowledgments

This project was supported by funding from the VA Health Services Research and Development service. Dr. Caplan is supported by a VA HSR&D Career Development Award.

Conflicts of interest

We declare that we have no financial and personal relationships with other people or organizations that could inappropriately influence (bias) this work, including employment, consultancies, stock ownership, honoraria, paid expert testimony, patents or patent applications, and travel grants, all within 5 years of beginning the work submitted. The manuscript has not been published, submitted, nor is not simultaneously being submitted elsewhere.

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Authors and Affiliations

  1. Denver VA Medical Center, 1055 Clermont St, Research 151, Denver, CO, 80220, USA

    L. Caplan, A. E. Hines, E. Williams, A. V. Prochazka & E. Hutt

  2. University of Colorado School of Medicine, Denver, CO, USA

    L. Caplan, A. V. Prochazka & E. Hutt

  3. Center for Education and Research on Therapeutics of Musculoskeletal Disorders, University of Alabama at Birmingham, FOT 840, 510 20th Street South, Birmingham, AL, 35294, USA

    K. G. Saag

  4. University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA

    K. G. Saag

  5. Veterans Affairs Pharmacy Benefits Management, M/S 119D, Building 37, Room 139, Hines, IL, 60141, USA

    F. Cunningham

  6. University of Colorado Denver, P.O. Box 6511, B115, Denver, CO, 80045, USA

    L. Caplan

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  1. L. Caplan
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  2. A. E. Hines
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Correspondence to L. Caplan.

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The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

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Caplan, L., Hines, A.E., Williams, E. et al. An observational study of glucocorticoid-induced osteoporosis prophylaxis in a national cohort of male veterans with rheumatoid arthritis. Osteoporos Int 22, 305–315 (2011). https://doi.org/10.1007/s00198-010-1201-x

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  • DOI: https://doi.org/10.1007/s00198-010-1201-x

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