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Glucocorticoid-induced osteoporosis management among seniors, by year, sex, and indication, 1996–2012

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Abstract

Summary

We identified that glucocorticoid-induced osteoporosis management (bone mineral density testing or osteoporosis treatment) among seniors improved among men (2 to 23 %) and women (10 to 48 %) between 1996 and 2007, and then remained relatively stable through to 2012. Differences were also noted by indication (from a low of 21 % for respiratory conditions to a high of 41 % for rheumatic conditions).

Purpose

The aim of our study was to describe the proportion of chronic oral glucocorticoid (GC) users that receive osteoporosis management (bone mineral density test or osteoporosis treatment) by sex and over time.

Methods

We identified community-dwelling older adults initiating chronic oral GC therapy in Ontario using pharmacy data from 1996 to 2012. Chronic GC use was defined as greater than or equal to two oral GC prescriptions dispensed and ≥450 mg prednisone equivalent over a 6-month period. Osteoporosis management within 6 months of starting chronic GC therapy was examined by sex, year, indication for therapy, and osteoporosis management history. Results were summarized using descriptive statistics.

Results

We identified 72,099 men and 95,975 women starting chronic oral GC therapy (mean age = 74.9 years, SD = 6.5). Approximately two thirds of patients (65 %) received ≥900 mg within the 6-month chronic use window. GC-induced osteoporosis management increased from 2 to 23 % (men) and 10 to 48 % (women) between 1996 and 2007, and then remained relatively stable through to 2012. A higher proportion of patients with prior osteoporosis management were managed within 6 months (56 % men, 67 % women) of chronic GC use, compared to patients without prior management (12 % men, 23 % women). Patients with rheumatic disease were managed most commonly (41 %), and patients with respiratory conditions were managed least commonly (21 %).

Conclusions

GC-induced osteoporosis management improved significantly over time for both sexes yet remains low. Significant care gaps by sex and between clinical areas represent a missed opportunity for fracture prevention among patients requiring chronic GC therapy.

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References

  1. Stahn C, Lowenberg M, Hommes DW, Buttgereit F (2007) Molecular mechanisms of glucocorticoid action and selective glucocorticoid receptor agonists. Mol Cell Endocrinol 275(1-2):71–78

    Article  CAS  PubMed  Google Scholar 

  2. Diez-Perez A, Hooven FH, Adachi JD, Adami S, Anderson FA, Boonen S, Chapurlat R, Compston JE, Cooper C, Delmas P, Greenspan SL, Lacroix AZ, Lindsay R, Netelenbos JC, Pfeilschifter J, Roux C, Saag KG, Sambrook P, Silverman S, Siris ES, Watts NB, Nika G, Gehlbach SH (2011) Regional differences in treatment for osteoporosis. The Global Longitudinal Study of Osteoporosis in Women (GLOW). Bone 49(3):493–498

    Article  PubMed  Google Scholar 

  3. Donnan PT, Libby G, Boyter AC, Thompson P (2005) The population risk of fractures attributable to oral corticosteroids. Pharmacoepidemiol Drug Saf 14(3):177–186

    Article  PubMed  Google Scholar 

  4. Overman RA, Yeh JY, Deal CL (2013) Prevalence of oral glucocorticoid usage in the United States: a general population perspective. Arthritis Care Res 65(2):294–298

    Article  Google Scholar 

  5. Hallberg I, Bachrach-Lindstrom M, Hammerby S, Toss G, Ek A-C (2009) Health-related quality of life after vertebral or hip fracture: a seven-year follow-up study. BMC Musculoskelet Disord 10(1):135

    Article  PubMed Central  PubMed  Google Scholar 

  6. Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D (2000) Risk of mortality following clinical fractures. Osteoporos Int 11(7):556–561

    Article  CAS  PubMed  Google Scholar 

  7. Cadarette SM, Burden AM (2011) The burden of osteoporosis in Canada. Can Pharm J (Ott) 144(1 suppl):S3

    Google Scholar 

  8. Weinstein R (2001) Glucocorticoid-induced osteoporosis. Rev Endocr Metab Disord 2(1):65–73

    Article  CAS  PubMed  Google Scholar 

  9. Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, Hanley DA, Hodsman A, Jamal SA, Kaiser SM, Kvern B, Siminoski K, Leslie WD (2010) 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 182(17):1864–1873

    Article  PubMed Central  PubMed  Google Scholar 

  10. Saag KG, Gehlbach SH, Curtis JR, Youket TE, Worley K, Lange JL (2006) Trends in prevention of glucocorticoid-induced osteoporosis. J Rheumatol 33(8):1651–1657

    PubMed  Google Scholar 

  11. Curtis JR, Westfall AO, Allison JJ, Becker A, Casebeer L, Freeman A, Spettell CM, Weissman NW, Wilke S, Saag KG (2005) Longitudinal patterns in the prevention of osteoporosis in glucocorticoid-treated patients. Arthritis Rheum 52(8):2485–2494

    Article  PubMed  Google Scholar 

  12. Ettinger B, Chidambaran P, Pressman A (2001) Prevalence and determinants of osteoporosis drug prescription among patients with high exposure to glucocorticoid drugs. Am J Manage Care 7(6):597–605

    CAS  Google Scholar 

  13. Albaum JM, Youn S, Lévesque LE, Gershon AS, Cadarette SM (2014) Glucocorticoid-induced osteoporosis management: a systematic review. J Popul Ther Clin Pharmacol 31(3):e486–e504

    Google Scholar 

  14. Levy AR, O’Brien BJ, Sellors C, Grootendorst P, Willison D (2003) Coding accuracy of administrative drug claims in the Ontario Drug Benefit database. Can J Clin Pharmacol 10(2):67–71

    PubMed  Google Scholar 

  15. Iron KZB, Sykora K, Manuel DG (2008) Living and dying in Ontario: an opportunity for improved health information. ICES investigative report. Institute for Clinical Evaluative Sciences, Toronto

    Google Scholar 

  16. Juurlink DPC, Croxford R, Chong A, Austin P, Tu J, Laupacis A (2006) Canadian institute for health information discharge abstract database: a validation study. Institute for Clinical Evaluative Sciences, Toronto

    Google Scholar 

  17. Schneeweiss S, Avorn J (2005) A review of uses of health care utilization databases for epidemiologic research on therapeutics. J Clin Epidemiol 58(4):323–337

    Article  PubMed  Google Scholar 

  18. Cadarette SM, Carney G, Baek D, Gunraj N, Paterson JM, Dormuth CR (2012) Osteoporosis medication prescribing in British Columbia and Ontario: impact of public drug coverage. Osteoporos Int 23(4):1475–1480

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Gershon AS, Wang C, Guan J, Vasilevska-Ristovska J, Cicutto L, To T (2009) Identifying patients with physician-diagnosed asthma in health administrative databases. Can Respir J 16(6):183–188

    PubMed Central  PubMed  Google Scholar 

  20. Gershon AS, Wang C, Guan J, Vasilevska-Ristovska J, Cicutto L, To T (2009) Identifying individuals with physcian diagnosed COPD in health administrative databases. COPD 6(5):388–394

    Article  CAS  PubMed  Google Scholar 

  21. Benchimol EI, Guttmann A, Mack DR, Nguyen GC, Marshall JK, Gregor JC, Wong J, Forster AJ, Manuel DG (2014) Validation of international algorithms to identify adults with inflammatory bowel disease in health administrative data from Ontario, Canada. J Clin Epidemiol 67(8):887–896

    Article  PubMed  Google Scholar 

  22. Cadarette SM, Jaglal SB, Raman-Wilms L, Beaton DE, Paterson JM (2011) Osteoporosis quality indicators using healthcare utilization data. Osteoporos Int 22(5):1335–1342

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Majumdar SR, Lix LM, Yogendran M, Morin SN, Metge CJ, Leslie WD (2012) Population-based trends in osteoporosis management after new initiations of long-term systemic glucocorticoids (1998-2008). J Clin Endocrinol Metab 97(4):1236–1242

    Article  CAS  PubMed  Google Scholar 

  24. Smith MD, Cheah SP, Taylor K, Ahern MJ (2001) Prevention of corticosteroid induced osteoporosis in inpatients recently discharged from a tertiary teaching hospital. J Rheumatol 28(3):566–570

    CAS  PubMed  Google Scholar 

  25. Mudano A, Allison J, Hill J, Rothermel T, Saag K (2001) Variations in glucocorticoid induced osteoporosis prevention in a managed care cohort. J Rheumatol 28(6):1298–1305

    CAS  PubMed  Google Scholar 

  26. van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C (2000) Oral corticosteroids and fracture risk: relationship to daily and cumulative doses. Rheumatology (Oxford, England) 39(12):1383–1389

    Article  Google Scholar 

  27. De Vries F, Bracke M, Leufkens HG, Lammers JW, Cooper C, Van Staa TP (2007) Fracture risk with intermittent high-dose oral glucocorticoid therapy. Arthritis Rheum 56(1):208–214

    Article  PubMed  Google Scholar 

  28. Solomon DH, Johnston SS, Boytsov NN, McMorrow D, Lane JM, Krohn KD (2014) Osteoporosis medication use after hip fracture in U.S. Patients between 2002 and 2011. J Bone Miner Res 29(9):1929–1937

    Article  PubMed Central  PubMed  Google Scholar 

  29. Grossman JM, Gordon R, Ranganath VK, Deal C, Caplan L, Chen W, Curtis JR, Furst DE, McMahon M, Patkar NM, Volkmann E, Saag KG (2010) American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res 62(11):1515–1526

    Article  Google Scholar 

Download references

Acknowledgments

This research was supported by an Ontario Ministry of Research and Innovation Early Research Award and a University of Toronto Connaught New Researcher Award to Dr. Suzanne Cadarette. Dr. Cadarette was supported by a Canadian Institutes of Health Research New Investigator Award in Aging and Osteoporosis (MSH-95364). Jordan Albaum was supported by a Queen Elizabeth II Graduate Scholarship in Science and Technology and received an Osteoporosis Canada Tim Murray Short-Term Training Award to present this research at the 2014 American Society for Bone and Mineral Research Annual Conference in Houston, Texas. All analyses were completed at the ICES University of Toronto (UofT) satellite site with support from the Leslie Dan Faculty of Pharmacy, UofT. All opinions, results, and conclusions are those of the authors and do no not represent the views of ICES or the Ontario government. The authors thank Yan Yun Liu, University of Toronto, Andrea Burden, PhD, University of Toronto, and Mina Tadrous, PharmD, PhD, University of Toronto, for insightful discussions.

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None.

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Authors and Affiliations

  1. Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada

    J. M. Albaum & S. M. Cadarette

  2. Queen’s University, Kingston, ON, Canada

    L. E. Lévesque & G. Liu

  3. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

    L. E. Lévesque, A. S. Gershon, G. Liu & S. M. Cadarette

  4. Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    A. S. Gershon

Authors
  1. J. M. Albaum
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  2. L. E. Lévesque
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  3. A. S. Gershon
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  4. G. Liu
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  5. S. M. Cadarette
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Correspondence to S. M. Cadarette.

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Albaum, J.M., Lévesque, L.E., Gershon, A.S. et al. Glucocorticoid-induced osteoporosis management among seniors, by year, sex, and indication, 1996–2012. Osteoporos Int 26, 2845–2852 (2015). https://doi.org/10.1007/s00198-015-3200-4

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  • DOI: https://doi.org/10.1007/s00198-015-3200-4

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