Document Detail


Access to bone densitometry increases general practitioners' prescribing for osteoporosis in steroid treated patients.
MedLine Citation:
PMID:  14722208     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Availability of access to bone densitometry in the UK varies widely and there are concerns as to appropriate prescribing. Studies suggest inadequate use of osteoporosis prophylaxis in steroid users, despite recent guidelines. OBJECTIVE: To examine in a case-control study whether access to bone densitometry affects GPs' osteoporosis prescribing in high risk steroid users. METHOD: 10 general practices were included, five from primary care trusts (PCTs) with access to bone densitometry and five with limited access. Patients receiving prednisolone for >3 months were identified by database search. Patients receiving no prophylaxis other than calcium and vitamin D (Ca/D) were subsequently included. Appropriate patients in five practices were offered DXA scan (cases) and review. Patients in practices without access to scans (controls) were reviewed. GPs' opinions leading to treatment were sought by structured questionnaire. RESULTS: 132 (0.12%) patients were receiving prednisolone for >/=3 months, but no osteoporosis prophylaxis other than Ca/D. Pre-study prophylaxis ranged from 18 to 36%. Of 48 patients scanned, 21 (44%) were abnormal and 18 (38%) received new treatment. 13/44 (30%) controls received new treatment. 10/21 (48%) with abnormal scans started a bisphosphonate, compared with 7/44 (16%) controls (RR = 3, p = 0.004). No difference in risk factors for fracture was found in treated and untreated controls. CONCLUSIONS: GPs were three times more likely to start potent osteoporosis treatment after abnormal scans than GPs relying on clinical information. In practice, risk factors were not adequately assessed. Database searches may identify patients needing osteoporosis prophylaxis; however, DXA enables more appropriate patient treatment.
Authors:
A L Dolan; E Koshy; M Waker; C M Goble
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of the rheumatic diseases     Volume:  63     ISSN:  0003-4967     ISO Abbreviation:  Ann. Rheum. Dis.     Publication Date:  2004 Feb 
Date Detail:
Created Date:  2004-01-14     Completed Date:  2004-02-24     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0372355     Medline TA:  Ann Rheum Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  183-6     Citation Subset:  IM    
Affiliation:
Department of Rheumatology, Queen Elizabeth Hospital, Greenwich, London, SE18, UK. ldolan@btinternet.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Bone Density
Cross-Sectional Studies
Diphosphonates / therapeutic use*
Female
Glucocorticoids / therapeutic use*
Humans
Information Dissemination
Male
Middle Aged
Osteoporosis / chemically induced,  physiopathology,  prevention & control*
Physician's Practice Patterns*
Prednisolone / therapeutic use*
Chemical
Reg. No./Substance:
0/Diphosphonates; 0/Glucocorticoids; 50-24-8/Prednisolone
Comments/Corrections

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