Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Screening and Treatment of Glucocorticoid Induced Osteoporosis in a Large U.S. National Pharmacy Database.

Outman2,  Ryan C., Markward1,  Nathan J., Khalid1,  Mona, Aubert1,  Ronald E., Curtis2,  Jeffrey R., Epstein1,  Robert S., Frueh1,  Felix W.

Medco Health Solutions, Inc.
Univ of Alabama at Birmingham, Birmingham, AL

Statement of Purpose:

Despite a significant associated fracture risk, previous population-based studies document low screening and treatment rates for individuals with glucocorticoid(GC)-induced osteoporosis (GIOP). Using data from a national pharmacy benefit manager, we evaluated the influence of physician specialty on the rates and predictors of bone mineral density (BMD) measurement and anti-osteoporotic prescriptions among patients who received 90 or more days of GC therapy between January 2004 and December 2006.

Methods:

Using integrated medical and pharmacy data, we identified GC users and the physician that most frequently prescribed the GC prescriptions. In the 12 months following the 90 days of GC exposure, we also identified the presence of BMD tests and prescription medications commonly used to prevent or treat GIOP, including GIOP-specific therapies and hormone replacement therapy. BMD tests and GIOP prescription medications did not have to be ordered by the GC prescribing physician in order to be credited as having been done. Multivariable logistic regression was employed to examine the influence of physician specialty on BMD testing and GIOP prescribing patterns.

Summary of Results:

106,310 chronic GC users treated by 53,766 physicians were identified during the data extraction process and followed for 12 months after satisfying the 90-day exposure threshold. The mean age of the sample was 61 (SD = 18) years, and 59% were female. In the 12 months prior to satisfying the 90-day exposure threshold, GC-associated conditions and their relative frequencies included rheumatoid arthritis (6%), systemic lupus erythematosus (<1%), chronic obstructive pulmonary disease (5%), asthma (3%), and inflammatory bowel disease (<1%).

During the 12 month follow-up period, overall rates of BMD testing and any GIOP prescription medication were 4.6% and 23.5%, respectively. GIOP prescription medication use was 11.4% among women < 50, 32.3% among women 50–70, and 42.1% among women >70. BMD testing and GIOP medication use were significantly greater among women >= 50 (6.4 and 36.8%) compared to men (3.5% and 14.7%, p < 0.001) and women <50 (3.6% and 11.4%, p < 0.001).

After adjusting for patient age, gender, and GC-related baseline covariates, BMD testing was found to differ significantly by specialty of GC prescriber (internal medicine referent): endocrinology [OR = 1.61 (1.28–2.03)], gastroenterology [OR = 1.52 (1.27–1.81)], nephrology [OR = 1.78 (1.48–2.15)], and rheumatology [OR = 1.38 (1.26–1.51)]. GIOP medication use also differed by specialty (internal medicine referent): other [OR = 0.78 (0.75, 0.82)]; endocrinology [OR = 0.73 (0.64, 0.85)], gastroenterology [OR = 1.15 (1.05, 1.27)], nephrology [OR = 1.37 (1.23, 1.51)], pulmonology [OR = 1.34 (1.25, 1.45)], and rheumatology [OR = 1.59 (1.52, 1.67)].

Conclusions:

Among high-risk individuals, both BMD screening and GIOP treatment rates remain low even through 2007, particularly for pre-menopausal women and men of all ages. Significant practice pattern variations among specialties persist. Developing interventions to improve GIOP management remains a high priority.

To cite this abstract, please use the following information:
Outman, Ryan C., Markward, Nathan J., Khalid, Mona, Aubert, Ronald E., Curtis, Jeffrey R., Epstein, Robert S., et al; Screening and Treatment of Glucocorticoid Induced Osteoporosis in a Large U.S. National Pharmacy Database. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1561
DOI: 10.1002/art.29327

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