Improving trends in glucocorticoid-induced osteoporosis management: 2002 to 2006

In 2002 we undertook an audit of GIO (glucocorticoid-induced osteoporosis) management in the outpatient clinics of our university teaching hospital and found a wide variation in practice and considerable under-treatment of patients. We re-audited our practice in 2006.

A retrospective chart audit was undertaken over a 4-month period of 3,475 patients attending the 3 medical specialty outpatient clinics that were originally audited in 2002. All glucocorticoid (GC) users over the past 6 months were identified. Demographic data and treatment details were extracted, and findings were compared with the previous audit.

Two hundred and fifty-three (7%) patients were identified to be taking GC vs. 104 (2%) in 2002. GIO risk was documented in 71% (179) (p < 0.001) of the charts vs. 13% (19) in the previous audit. In 2002, 56% (58) were on some form of bone protection [53% (55) on Ca/vitamin D and 29% (30) on a bisphosphonate] whereas in 2006 the figures were 86% (219), 82% (207) and 57% (144), respectively. DXA scanning was performed in 32% (82) of our patients in 2006. Nonetheless, considerable variation in practice was still seen, with prescription rates for anti-resorptive therapy varying from 24%-70% and those for Ca/vitamin D supplements ranging from 15%-95% for different services. For the highest risk patients, the prescription rates by specialty ranged from 36%-72% for anti-resorptive therapy and 76%-95% for Ca/vitamin D supplements.

Over 4 years, major improvements in GIO management have taken place in our institution, with almost a doubling of the prescription of bone protectants. However, there still remains a considerable variation in individual practices and an under-utilisation of DXA scanning. We believe that these overall, encouraging findings can be generalized to similar institutions elsewhere.