Population-Based Trends in Osteoporosis Management after New Initiations of Long-Term Systemic Glucocorticoids (1998-2008)
Population-Based Trends in Osteoporosis Management after New Initiations of Long-Term Systemic Glucocorticoids (1998-2008)
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DOI：
10.1210/jc.2011-2645
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发表时间：
2012-04-01
影响因子：
5.8
通讯作者：
Leslie, W. D.
中科院分区：
文献类型：
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作者：
Majumdar, S. R.;Lix, L. M.;Leslie, W. D.
目的：我们的目标是描述1998-2008年间糖皮质激素性骨质疏松症(GIOP)预防护理的变化，包括骨密度(BMD)检测和骨质疏松症治疗在新的长期糖皮质激素治疗中的比率和相关性。方法：使用链接的医疗保健数据库，对加拿大马尼托巴省20岁或以上的成年人进行了一项基于人群的研究。在每个财政年度内发现了新的长期(90天)全身性糖皮质激素启动试验的受试者。高质量的GIOP预防护理的定义是在开始使用糖皮质激素后6个月内进行骨密度检测或骨质疏松治疗。对于每一次启动，我们确定了社会人口学和临床特征、泼尼松剂量当量和处方者专业。结果：我们研究了17,736例新的长期糖皮质激素治疗，其中三分之一每天至少服用10 mg强的松，大多数(%)是由全科医生开出的。总体而言，6个月骨密度检测率为6%，骨质疏松症治疗为22%，综合检测或治疗为25%。从1998年到2008年，骨密度检测(从4%到6%)、骨质疏松症治疗(从15%到24%)和检测或治疗[从17%到27%；aIRR=1.51；95%可信区间(CI)=1.40-1.63]略有增加。高质量的GIOP预防护理因年龄(70岁者为16%；aIRR=0.57；95%CI=0.52-0.63)、性别(男性13%对女性34%；aIRR=0.40；95%CI=0.37-0.43)和处方者(23%对44%风湿病；aIRR=0.56；95%CI=0.52-0.60)而显著不同。结论：GIOP预防护理的质量有所提高，但仍不理想，只有四分之一开始长期服用糖皮质激素的患者接受了BMD检测或骨质疏松治疗。需要采取干预措施来改善牙周炎的预防，特别是针对年轻患者、男性和非专科医生。(临床内分泌代谢酶97：1236-1242,2012)
Objectives: Our objective was to describe changes in glucocorticoid-induced osteoporosis (GIOP) preventive care from 1998-2008 including rates and correlates of bone mineral density (BMD) testing and osteoporosis treatment in new long-term glucocorticoid initiations.Methods: A population-based study of adults aged 20 yr or older in Manitoba, Canada, was conducted using linked healthcare databases. Subjects with new long-term (>= 90 d) systemic glucocorticoid initiations were identified within each fiscal year. High-quality GIOP preventive care was defined by the composite of BMD testing or osteoporosis treatment within 6 months of starting glucocorticoids. For each initiation, we identified sociodemographic and clinical characteristics, prednisone dose equivalents, and prescriber specialty. Multivariable Poisson regression models were used to calculate adjusted incidence rate ratios (aIRR).Results: We studied 17,736 new long-term glucocorticoid initiations; one third were at least 10 mg prednisone daily, and most (64%) were prescribed by general practitioners. Overall, 6-month rates of BMD testing were 6%, osteoporosis treatment 22%, and the composite of testing or treatment 25%. From 1998-2008, there were modest increases in BMD testing (from 4 to 6%), osteoporosis treatment (from 15 to 24%), and testing or treatment [from 17 to 27%; aIRR = 1.51; 95% confidence interval (CI) = 1.40-1.63]. High-quality GIOP preventive care varied significantly by age (16% for those = 70 yr; aIRR = 0.57; 95% CI = 0.52-0.63), sex (13% for men vs. 34% for women; aIRR = 0.40; 95% CI = 0.37-0.43), and prescriber (23% general practice vs. 44% rheumatology; aIRR = 0.56; 95% CI = 0.52-0.60).Conclusions: Quality of GIOP preventive care has improved but remains suboptimal with only one quarter of those starting long-term glucocorticoids receiving BMD testing or osteoporosis treatment. Interventions to improve GIOP prevention, especially targeting younger patients, men, and nonspecialists, are needed. (J Clin Endocrinol Metab 97: 1236-1242, 2012)