Osteoporosis management among chronic glucocorticoid users: a systematic review.

BACKGROUND: Clinical practice guidelines recommend that all patients starting chronic oral glucocorticoid (GC) therapy receive bone mineral density (BMD) testing and osteoporosis pharmacotherapy.

OBJECTIVE: We completed a systematic review of observational studies to examine the proportion of patients on chronic oral GC therapy who receive osteoporosis management.

METHODS: Two independent reviewers completed a systematic search of Ovid MEDLINE® and EMBASE® to identify all English language articles that examined the prevalence of osteoporosis management among chronic oral GC users. Clinical trials, abstracts, reviews, commentaries, and letters to the editor were excluded. Study methods and results (use of BMD testing and osteoporosis pharmacotherapy) were abstracted and summarized by year and region.

RESULTS: We identified 29 eligible studies published between 1999 and October 2013: 17 were conducted in North America, 5 in Europe, and 7 in other regions. Heterogeneity between patient populations and methods used to define chronic GC use precluded the direct comparison of results between regions, or over time. Over 80% of studies identified that < 40% of chronic oral GC users received BMD testing or osteoporosis pharmacotherapy. When results of these studies were plotted by year, there was little evidence of improvement in osteoporosis management over time.

CONCLUSIONS: Despite consistent recommendations to target osteoporosis prevention at the onset of chronic oral GC therapy, osteoporosis is undermanaged among chronic oral GC users. Targeted interventions are needed to help reduce the burden of fracture-related morbidity associated with GC-induced osteoporosis.