%0 Journal Article
%T Utilization of Preventive Measures for Glucocorticoid-Induced Osteoporosis among Veterans with Inflammatory Bowel Disease
%A Aikaterini Thanou
%A Tauseef Ali
%A Omar Haq
%A Sindhu Kaitha
%A Jordan Morton
%A Stavros Stavrakis
%A Mary Beth Humphrey
%J ISRN Gastroenterology
%D 2013
%R 10.1155/2013/862312
%X Purpose. We examined current osteoporosis prevention practices in patients with inflammatory bowel disease (IBD) on chronic steroid using the 2003 American Gastroenterological Association guidelines as standard of care. Methods. We identified all IBD patients followed at the Oklahoma City VA Medical Center from January 2003 to December 2010, who had been on daily oral steroids (prednisone ¡Ý5£¿mg or budesonide ¡Ý6£¿mg) for ¡Ý3 consecutive months. Associations of calcium and vitamin D (vitD) prescribing and bone mineral density (BMD) testing with patient characteristics were examined by logistic regression. Results. Sixty-three of 384 consecutive patients met inclusion criteria. Among 86 steroid courses, calcium and vitD were concurrently prescribed in 46%, and BMD was tested in 30%. There was no association of demographic and clinical characteristics with calcium/vitD prescribing and BMD testing. By multivariate analysis, steroid initiation after 2006, compared to before 2006, was associated with a significant increase in calcium (OR = 3.17 and ) and vitD (OR = 2.96 and ) prescribing and BMD testing (OR = 4.63 and ). Conclusions. We observed a low, yet increasing, adherence to osteoporosis prevention guidelines in IBD since 2003, which highlights the need for continued physician education to enhance guideline awareness and implementation. 1. Introduction Patients with inflammatory bowel disease (IBD) have an increased prevalence of osteoporosis ranging from 17% to 41% [1], whereas low bone mass has been shown to translate into an up to a 40% higher relative risk of fractures in this population [2]. The etiology of osteoporosis in IBD is multifactorial, with risk factors including malnutrition, calcium and vitamin D malabsorption, immobilization, corticosteroid use, and the underlying inflammatory state [3]. Steroid-induced osteoporosis is a specific concern in IBD patients because it is associated with rapid loss of bone mass soon after steroid initiation and translates into an increased fracture risk, independent of that determined by age and bone mineral density (BMD) alone [4, 5]. Despite the availability of therapies to reduce fracture risk, patients on long-term steroids often do not receive any intervention to prevent or treat osteoporosis [6, 7]. Guidelines for osteoporosis screening and prevention in IBD patients on chronic corticosteroids were published by the American Gastroenterological Association (AGA) in 2003 [1]. According to the AGA guidelines, IBD patients with any additional risk factors for osteoporosis, for example, prolonged
%U http://www.hindawi.com/journals/isrn.gastroenterology/2013/862312/