Monotoring and management of bone status in patients on chronic glucocorticoid treatment - the medscheme experience

Abstract

Objective: Review of administrative databases to gain insight into the investigation, management and sequelae of bone disease in patients on long-term glucocorticoid treatment. Design: Retrospective analysis of 1998 pharmaceutical and clinical claims data for ± 2 million lives administered by Medscheme. Data were extracted for members registered with the chronic medication programme as eligible for chronic glucocorticoid treatment. Those identified were subjected to further review for evidence of osteoporosis and/or hip fracture. Subgroup analysis of peri- and postmenopausal women was carried out and compared against a control group. Main outcame measures: Osteoporosis investigation and treatment rates in males and females; frequency of hip fractures; prescribing profiles; role of underlying disease, glucocorticoid route, gender and age in development of osteoporosis. Results: A total of 1614 subjects (54% females) was registered for chronic glucocorticoid treatment. Osteoporosis was diagnosed in 14.1% of females and 5.9% of males across abroad age range. Hip fractures were recorded for one female and three males. The subgroup analysis showed that osteoporosis was ± 1.5 times more common in women receiving glucocorticoids than in peri- and postmenopausal controls, and that there was greater use of vitamin D and calcium supplementation and bisphosphonates in those exposed to glucocorticoids. Multivariate analysis showed overall that female gender, increasing age and oral glucocorticoids were significantly related to osteoporosis. Conclusion: Reference to UK and US data suggests that while local practitioners are aware of the effect of glucocorticoids on bone, the level of awareness is probably suboptimal, especially with regard to male patients.

S Afr Med J 20OO 90: 1125-1129