RESEARCH - Educational program increases prescribing of preventive medication for steroid-induced osteoporosis

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Multifaceted Educational Program Increases Prescribing of Preventive

Medication for Corticosteroid Induced Osteoporosis

Osteoporosis is a major public health problem and its prevalence is

increasing1. In Australia, roughly one in 2 women and one in 4 men over the

age of 60 years will develop an osteoporotic fracture2.

While corticosteroid drugs can produce striking improvement in a number of

diseases, a major limiting factor is the risk of serious complications with

longterm treatment, including osteoporosis. A number of studies have

reported decreases in bone mineral density and/or an increase in fracture

risk during oral corticosteroid treatment3-7. Corticosteroid induced

osteoporosis is the most common type of secondary osteoporosis8.

Epidemiological data suggest that corticosteroid treatment doubles the risk

of fractures of the hip and distal radius, and at least quadruples the risk

of vertebral fracture6.

MARK NAUNTON, GREGORY M. PETERSON, GRAEME JONES, GILLIAN M. GRIFFIN, and

MARTIN D. BLEASEL

ABSTRACT.

Objective. Despite evidence that oral corticosteroids increase fracture risk

and the existence of guidelines for the prevention of corticosteroid induced

osteoporosis, few patients prescribed longterm corticosteroids receive

osteoporosis prevention. We performed a controlled trial of a comprehensive

educational program aimed at increasing the use of osteoporosis preventive

therapy in patients prescribed longterm oral corticosteroids.

Methods. The intervention was conducted in Southern Tasmania, Australia,

using Northern Tasmania as a control area. All general practitioners and

community pharmacies were sent educational material and locally produced

guidelines on the prevention of corticosteroid induced osteoporosis. This

was followed by academic detailing visits and reminders. Pharmacists were

provided with supplies of an educational refrigerator magnet, intended for

patients. Outcomes were measured using evaluation feedback from the general

practitioners and pharmacists, and drug utilization data provided by (1) a

series of patients presenting to hospital and taking oral corticosteroids

for at least 3 consecutive months; and (2) dispensing of osteoporosis

preventive therapy under the Australian Pharmaceutical Benefits Scheme.

Results. The prevalence of osteoporosis preventive therapy increased from

31% of admitted hospital patients taking longterm oral corticosteroids to

57% postintervention (p < 0.0001). The use of bisphosphonates (6% to 24% of

patients), calcium (5% to 19%), and vitamin D (3% to 11%) all increased

significantly. Prescription data also indicated a significant (p < 0.01)

increase in the use of osteoporosis preventive therapy in the intervention

region.

Conclusion. A multifaceted education program, incorporating academic

detailing of general practitioners and community pharmacists, increased the

use of osteoporosis prevention strategies in longterm oral corticosteroid

users. (J Rheumatol 2004;31:550-6)

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From the Tasmanian School of Pharmacy and Menzies Research Institute,

Faculty of Health Science, University of Tasmania, and Pharmacy Department,

Royal Hobart Hospital, Hobart, Tasmania, Australia.

Supported by The Royal Hobart Hospital Research Foundation.

M. Naunton, BPharm (Hons); G.M. , PhD, Professor of Pharmacy; G.M.

, BPharm (Hons), Tasmanian School of Pharmacy; M.D. Bleasel, PhD,

Tasmanian School of Pharmacy, Pharmacy Department, Royal Hobart Hospital; G.

, MD, Menzies Research Institute.

Address reprint requests to Dr. G.M. , Tasmanian School of Pharmacy,

Faculty of Health Science, University of Tasmania, GPO Box 252-26, Hobart,

Tasmania 7001, Australia. E-mail: G.@...

Submitted May 5, 2003; revision accepted August 19, 2003 .

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