Practice pattern variation among internal medicine specialists in the prevention of glucocorticoid-induced...

Osteoporosis is a serious side effect of long-term glucocorticoid (GC) use, but there is little success at prevention. We sought to identify academic physicians' awareness of glucocorticoid-induced osteoporosis (GIOP) risk and the patient and provider characteristics that determine GIOP management. A retrospective chart review of 365 patients seen at The University of Alabama at Birmingham by 4 rheumatologists, 3 pulmonologists, and 3 gastroenterologists was performed. Of these, 59.2% were women and 69.3% were Caucasians. Only 110 patients (30.1%) received any type of GIOP prevention intervention. The patients receiving GIOP prevention were older (58.7 +/- 13.8 vs. 49.8 +/- 16.7 years; p < 0.001); had longer duration of GC use (91.9 +/- 84.9 vs. 50.0 +/- 57.7 months; p < 0.001); and, for women, were more likely post-menopausal (81.5% vs. 18.5% premenopausal; p < 0.001). Fracture history was more common in those who received GIOP management (18 vs. 9 cases; p < 0.001). Calcium was the most commonly prescribed prevention strategy (84.5%). Recommendation of risk factor modification was seldom documented. Using multivariate logistic regression, rheumatologists were 4 times more likely to recommend GIOP prevention than the other two specialists. To improve the education in GIOP prevention strategies for specialists who commonly prescribe long-term GC, regular meetings and guidelines provided by experts in this field should be conducted. Both risk factors modification and pharmacological intervention for GIOP prevention should be started at the time of first GC prescription or as early as possible.