Status of Glucocorticoid-Induced Osteoporosis Preventive Care in Korea: A Retrospective Cohort Study on the Korean National Health Insurance Service Database.

Byung-Wook Song,A-Ran Kim,Seung-Geun Lee,Ho-Seob Kim,Min-A Kim

doi:10.3390/medicina58020324

Abstract

Background and Objectives: It is crucial to prevent osteoporosis in patients receiving long-term glucocorticoid (GC) treatment. This study aimed to investigate the frequency and associated factors of preventive care for glucocorticoid-induced osteoporosis (GIOP) in Korea. Materials and Methods: Using the Korean National Health Insurance Service database, we identified 37,133 individuals aged ≥ 20 years who commenced long-term (≥90 days) oral GC between 2011 and 2012. High-quality GIOP preventive care was defined as either a bone mineral density (BMD) test, calcium and/or vitamin D supplementation, or prescription osteoporosis medications within 6 months of GC initiation. Multivariable logistic regression models were used to calculate odds ratios (ORs) for associated factors for high-quality GIOP preventive care. Results: The mean age was 49.8 years, and 18,476 (49.8%) patients were female. The frequency of high-quality GIOP preventive care was only 3.68% (BMD test, 1.46%; osteoporosis medications, 1.65%; calcium/vitamin D, 1.63%). Increasing age (OR = 2.53, p < 0.001; 40–49 years, OR = 3.99, p < 0.001; 50–59 years, OR = 5.17, p < 0.001; 60–69 years, OR = 8.07, p < 0.001; ≥70 years, respectively), systemic autoimmune disease (OR = 3.08, p < 0.001), rural residence (OR = 1.19, p = 0.046), concomitant hyperthyroidism (OR = 1.58, p = 0.007), and malignancy (OR = 1.59, p < 0.001) were significantly associated with a higher likelihood of receiving high-quality GIOP preventive care. Male sex (OR = 0.26, p < 0.001) and GC prescription in primary care clinics and nursing hospitals (OR = 0.66, p < 0.001) were associated with a lower rate of high-quality GIOP preventive care. Conclusions: Most Korean patients treated with GC did not receive appropriate preventive care for GIOP in real-world practice. More efforts are needed by clinicians to prevent, screen, and treat GIOP.

Highlights

1% of the adult population worldwide are treated with long-term systemic glucocorticoids (GC), which are widely used for the management of a variety of disorders due to their anti-inflammatory and immunosuppressive properties; these disorders include systemic autoimmune diseases, inflammatory bowel diseases, chronic pulmonary diseases, allergic diseases, hematologic malignancy, and following organ transplants [1,2]
Long-term use of GC can cause a myriad of adverse effects, among which the most serious one is the reduction of bone density and derangement of bone quality, leading to glucocorticoid-induced osteoporosis (GIOP), the most common form of secondary osteoporosis
Rural residence, GC prescription for systemic autoimmune diseases, and concomitant hyperthyroidism and malignancy were found to be significantly associated with a higher likelihood of receiving high-quality GIOP preventive care, whereas male gender and medical care in primary care clinics/nursing hospitals were linked with a lower frequency of highquality GIOP preventive care

Summary

Introduction

1% of the adult population worldwide are treated with long-term systemic glucocorticoids (GC), which are widely used for the management of a variety of disorders due to their anti-inflammatory and immunosuppressive properties; these disorders include systemic autoimmune diseases, inflammatory bowel diseases, chronic pulmonary diseases, allergic diseases, hematologic malignancy, and following organ transplants [1,2]. Highquality GIOP preventive care was defined as either a bone mineral density (BMD) test, calcium and/or vitamin D supplementation, or prescription osteoporosis medications within 6 months of GC initiation. The frequency of high-quality GIOP preventive care was only 3.68% (BMD test, 1.46%; osteoporosis medications, 1.65%; calcium/vitamin D, 1.63%). Increasing age (OR = 2.53, p < 0.001; 40–49 years, OR = 3.99, p < 0.001; 50–59 years, OR = 5.17, p < 0.001; 60–69 years, OR = 8.07, p < 0.001; ≥70 years, respectively), systemic autoimmune disease (OR = 3.08, p < 0.001), rural residence (OR = 1.19, p = 0.046), concomitant hyperthyroidism (OR = 1.58, p = 0.007), and malignancy (OR = 1.59, p < 0.001) were significantly associated with a higher likelihood of receiving high-quality GIOP preventive care. More efforts are needed by clinicians to prevent, screen, and treat GIOP

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