Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.


Glucocorticoid-Induced Osteoporosis Program (GIOP): A Highly Successful Care Program with Improved Patient Outcomes After 2 Years

Matzko1,  Cynthia K., Newman1,  Eric D., Olenginski1,  Thomas P., Harrington1,  Thomas M., Maloney-Saxon II1,  Gwynne L., Wood2,  G. Craig

Geisinger Medical Center, Danville, PA
Geisinger Center for Health Research, Danville, PA

Purpose:

Chronic glucocorticoids (GC) users have a high risk of osteoporotic fracture and their osteoporotic care is often suboptimal. Our Rheumatology Department designed a program of care called GIOP (Glucocorticoid-Induced Osteoporosis Program). GIOP uses electronic tools, pathways of care, and dedicated personnel to provide comprehensive osteoporosis care. We report on the first 200 patients entered and their 2 year follow-up.

Method:

GIOP candidates were any patients taking GC >=3 months. Baseline evaluation included demographics, patient knowledge (pre-test), GC use, 25-OH Vitamin D level, DXA, and vertebral fracture analysis (VFA) or spine X-rays. High-risk was defined as T-score below - 1.0 or prevalent vertebral fracture. All patients were educated and instructed to take adequate calcium/Vitamin D, do weight bearing exercise, and implement safety strategies. Patients with Vitamin D levels below 30ng/ml were prescribed 50,000 IU supplementation. High-risk patients were prescribed medication. Patient knowledge (post-test), Vitamin D level, medication use and adherence were reassessed at 6 months, 12 months and 2 years.

Results:

At baseline (n=200), the mean age was 62.7 ± 12.7 years and 68.5% of the patients were women. Personal history of fracture was seen in 9.5% of patients (2.5% hip, 4.0% spine, 2.5% wrist). The mean GC duration was 5.9 ± 7.1 years and the mean daily dose ranged from 2.5 to 15 mg of prednisone for 84% of the patients. Vitamin D levels of <30 ng/ml were seen in 74% of patients. Baseline DXA, VFA, and spine X-rays categorized 70.5% of GC patients as High-risk. Two year paired follow-up data was available in 132 patients (17 died, 5 refused follow-up, and 46 unavailable). Test scores and vitamin D levels improved significantly (p= 0.001) (Table). Forty-four % of patients were taking a lower dose of steroid at 2 years compared with baseline (p=0.001). Overall adherence to calcium, vitamin D, and prescription medication (if indicated) was 97% at 2 years. Adherence specifically to bisphosphonates or teraparatide was 99% at 2 years.

Of the 132 patients with 2-year follow-up, a baseline and at least 1 follow-up DXA were available for 128 (97%). An increase in BMD at the spine of 2.66% (p<0.0001) was seen for the population overall and 3.63% for the high risk patients on medication (p<0.0001). Over the two year follow-up, 18 of the 132 patients (14%) sustained a hip, spine, or wrist fracture (hip: n=1, spine: n=17, wrist: n=2; Table). Of these 18 patients, 8 (45%) also had a fracture at baseline.

 Baseline2 Years
Test Scores69 ± 2188 ± 14
Vitamin D (ng/ml)20.6 ± 11.041.1 ± 13.6
Patients with fracture  
  Hip2.5%0.8%
  Spine16.0%12.9%
  Wrist0.0%1.5%
  Any of above18.5%13.6%

Conclusion:

Most patients entering GIOP are vitamin D deficient, high-risk and require treatment. Significant improvement was observed and sustained over 2 years in patient knowledge, Vitamin D levels following GIOP program treatment, and BMD at the spine. The mean daily steroid dose decreased. Despite the aging, high risk population, only a small percentage of patients sustained a fracture. Overall adherence to the prescribed regimen was excellent at 2 years. This well-organized, patient-centric program represents a highly successful model to improve bone health in patients requiring chronic GC.

To cite this abstract, please use the following information:
Matzko, Cynthia K., Newman, Eric D., Olenginski, Thomas P., Harrington, Thomas M., Maloney-Saxon II, Gwynne L., Wood, G. Craig; Glucocorticoid-Induced Osteoporosis Program (GIOP): A Highly Successful Care Program with Improved Patient Outcomes After 2 Years [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1921
DOI: 10.1002/art.26994

Abstract Supplement

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2009 ACR/ARHP