Management of glucocorticoid-induced osteoporosis in male veterans

To determine whether glucocorticoid-induced osteoporosis in male veterans was managed in accordance with American College of Rheumatology (ACR) guidelines. These guidelines recommend bone mineral density (BMD) determination at the initiation of long-term therapy with prednisone > or =7.5 mg/d, provision of hormone replacement therapy as needed, calcium and vitamin D supplementation as necessary, and antiresorptive therapy for low BMD.

Patients receiving prednisone > or =7.5 mg/d throughout a predefined six-month period were identified through a hospital pharmacy database. Electronic and paper chart review was carried out to determine whether BMD measurement by dual-energy X-ray absorptiometry had been performed. Supplemental calcium and vitamin D intake was assessed for each patient. In addition, pharmacy records were reviewed to determine whether antiresorptive therapy was prescribed for patients with low BMD.

The Wm. S. Middleton Veterans Affairs Medical Center, Madison, WI.

Seventy-two men met study criteria. They had been receiving oral prednisone treatment for a median of 30 months (range 6-74); mean daily dosage during the six-month study period was 12.5 mg (range 7.5-37.5). Extensive record review revealed that only six patients (8%) received recommended calcium and vitamin D, and only 43 (60%) had a BMD determination. Of those 43 men, 32 had T-scores below -1, therefore meeting ACR criteria for recommended antiresorptive therapy. However, only 12 of these 32 patients were prescribed antiresorptive therapy. Although this study was not designed to evaluate differences among clinics, there appeared to be better adherence to ACR guidelines for patients cared for in a rheumatology specialty clinic than in other clinics at the institution.

Adherence to ACR guidelines for management of glucocorticoid-induced osteoporosis was poor. Efforts to improve the prevention and management of glucocorticoid-induced osteoporosis in male veterans are warranted.