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. 2004 Feb;63(2):183–186. doi: 10.1136/ard.2003.006130

Access to bone densitometry increases general practitioners' prescribing for osteoporosis in steroid treated patients

A Dolan 1, E Koshy 1, M Waker 1, C Goble 1
PMCID: PMC1754894  PMID: 14722208

Abstract

Background: Availability of access to bone densitometry in the UK varies widely and there are concerns as to appropriate prescribing. Studies suggest inadequate use of osteoporosis prophylaxis in steroid users, despite recent guidelines.

Objective: To examine in a case-control study whether access to bone densitometry affects GPs' osteoporosis prescribing in high risk steroid users.

Method: 10 general practices were included, five from primary care trusts (PCTs) with access to bone densitometry and five with limited access. Patients receiving prednisolone for >3 months were identified by database search. Patients receiving no prophylaxis other than calcium and vitamin D (Ca/D) were subsequently included. Appropriate patients in five practices were offered DXA scan (cases) and review. Patients in practices without access to scans (controls) were reviewed. GPs' opinions leading to treatment were sought by structured questionnaire.

Results: 132 (0.12%) patients were receiving prednisolone for ⩾3 months, but no osteoporosis prophylaxis other than Ca/D. Pre-study prophylaxis ranged from 18 to 36%. Of 48 patients scanned, 21 (44%) were abnormal and 18 (38%) received new treatment. 13/44 (30%) controls received new treatment. 10/21 (48%) with abnormal scans started a bisphosphonate, compared with 7/44 (16%) controls (RR = 3, p = 0.004). No difference in risk factors for fracture was found in treated and untreated controls.

Conclusions: GPs were three times more likely to start potent osteoporosis treatment after abnormal scans than GPs relying on clinical information. In practice, risk factors were not adequately assessed. Database searches may identify patients needing osteoporosis prophylaxis; however, DXA enables more appropriate patient treatment.

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Selected References

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  1. Cohen S., Levy R. M., Keller M., Boling E., Emkey R. D., Greenwald M., Zizic T. M., Wallach S., Sewell K. L., Lukert B. P. Risedronate therapy prevents corticosteroid-induced bone loss: a twelve-month, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Arthritis Rheum. 1999 Nov;42(11):2309–2318. doi: 10.1002/1529-0131(199911)42:11<2309::AID-ANR8>3.0.CO;2-K. [DOI] [PubMed] [Google Scholar]
  2. Eastell R. Management of corticosteroid-induced osteoporosis. UK Consensus Group Meeting on Osteoporosis. J Intern Med. 1995 May;237(5):439–447. doi: 10.1111/j.1365-2796.1995.tb00868.x. [DOI] [PubMed] [Google Scholar]
  3. Grol R., Dalhuijsen J., Thomas S., Veld C., Rutten G., Mokkink H. Attributes of clinical guidelines that influence use of guidelines in general practice: observational study. BMJ. 1998 Sep 26;317(7162):858–861. doi: 10.1136/bmj.317.7162.858. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Gudbjornsson B., Juliusson U. I., Gudjonsson F. V. Prevalence of long term steroid treatment and the frequency of decision making to prevent steroid induced osteoporosis in daily clinical practice. Ann Rheum Dis. 2002 Jan;61(1):32–36. doi: 10.1136/ard.61.1.32. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Kanis J. A., Johnell O., Oden A., Dawson A., De Laet C., Jonsson B. Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int. 2001 Dec;12(12):989–995. doi: 10.1007/s001980170006. [DOI] [PubMed] [Google Scholar]
  6. Lindsay R., Silverman S. L., Cooper C., Hanley D. A., Barton I., Broy S. B., Licata A., Benhamou L., Geusens P., Flowers K. Risk of new vertebral fracture in the year following a fracture. JAMA. 2001 Jan 17;285(3):320–323. doi: 10.1001/jama.285.3.320. [DOI] [PubMed] [Google Scholar]
  7. Luengo M., Picado C., Del Rio L., Guañabens N., Montserrat J. M., Setoain J. Vertebral fractures in steroid dependent asthma and involutional osteoporosis: a comparative study. Thorax. 1991 Nov;46(11):803–806. doi: 10.1136/thx.46.11.803. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. McClung M. R., Geusens P., Miller P. D., Zippel H., Bensen W. G., Roux C., Adami S., Fogelman I., Diamond T., Eastell R. Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med. 2001 Feb 1;344(5):333–340. doi: 10.1056/NEJM200102013440503. [DOI] [PubMed] [Google Scholar]
  9. Peat I. D., Healy S., Reid D. M., Ralston S. H. Steroid induced osteoporosis: an opportunity for prevention? Ann Rheum Dis. 1995 Jan;54(1):66–68. doi: 10.1136/ard.54.1.66. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Rubin S. M., Cummings S. R. Results of bone densitometry affect women's decisions about taking measures to prevent fractures. Ann Intern Med. 1992 Jun 15;116(12 Pt 1):990–995. doi: 10.7326/0003-4819-116-12-990. [DOI] [PubMed] [Google Scholar]
  11. Saag K. G., Emkey R., Schnitzer T. J., Brown J. P., Hawkins F., Goemaere S., Thamsborg G., Liberman U. A., Delmas P. D., Malice M. P. Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis. Glucocorticoid-Induced Osteoporosis Intervention Study Group. N Engl J Med. 1998 Jul 30;339(5):292–299. doi: 10.1056/NEJM199807303390502. [DOI] [PubMed] [Google Scholar]
  12. Silverman S. L., Greenwald M., Klein R. A., Drinkwater B. L. Effect of bone density information on decisions about hormone replacement therapy: a randomized trial. Obstet Gynecol. 1997 Mar;89(3):321–325. doi: 10.1016/S0029-7844(97)85857-7. [DOI] [PubMed] [Google Scholar]
  13. Tosteson A. N., Rosenthal D. I., Melton L. J., 3rd, Weinstein M. C. Cost effectiveness of screening perimenopausal white women for osteoporosis: bone densitometry and hormone replacement therapy. Ann Intern Med. 1990 Oct 15;113(8):594–603. doi: 10.7326/0003-4819-113-8-594. [DOI] [PubMed] [Google Scholar]
  14. Verstraeten A., Dequeker J. Vertebral and peripheral bone mineral content and fracture incidence in postmenopausal patients with rheumatoid arthritis: effect of low dose corticosteroids. Ann Rheum Dis. 1986 Oct;45(10):852–857. doi: 10.1136/ard.45.10.852. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Walsh L. J., Wong C. A., Pringle M., Tattersfield A. E. Use of oral corticosteroids in the community and the prevention of secondary osteoporosis: a cross sectional study. BMJ. 1996 Aug 10;313(7053):344–346. doi: 10.1136/bmj.313.7053.344. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. van Staa T. P., Abenhaim L., Cooper C., Zhang B., Leufkens H. G. Public health impact of adverse bone effects of oral corticosteroids. Br J Clin Pharmacol. 2001 Jun;51(6):601–607. doi: 10.1046/j.0306-5251.2001.1385.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. van Staa T. P., Leufkens H. G. M., Cooper C. The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int. 2002 Oct;13(10):777–787. doi: 10.1007/s001980200108. [DOI] [PubMed] [Google Scholar]

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