Oral Corticosteroid Prescribing Patterns and Fracture Preventive Care

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Oral corticosteroids have been widely prescribed for various inflammatory conditions, such as eczema, asthma, and chronic obstructive pulmonary disease (COPD).

However, their prolonged use and high-dose prescriptions have been associated with an increased risk of fractures due to the detrimental impact on bone health.

Fracture prevention care, including interventions such as bone mineral density assessment and pharmacological treatments, is crucial in mitigating this risk.

While existing studies have explored the link between oral corticosteroid prescription patterns and fracture risk, few have examined this association independently of cumulative dosage.

Oral corticosteroid prescriptions have been linked to a number of adverse effects on bone health, including:

  • Osteoporosis: This is a condition characterized by low bone density, which makes bones more likely to break.
  • Avascular necrosis: This is a condition in which the blood supply to the bone is cut off, which can lead to bone death.
  • Muscle weakness: This can make it difficult to move around and can increase the risk of falls.
  • Delayed fracture healing: This can make it take longer for bones to heal after a break.

The risk of these adverse effects increases with the length of time that someone takes oral corticosteroids and with the dose of the medication. People who are at increased risk of bone loss from oral corticosteroids include:

  • Women: Women are more likely than men to develop osteoporosis.
  • People over the age of 65: Bone loss is more common with age.
  • People with a family history of osteoporosis: People who have a family history of osteoporosis are more likely to develop the condition themselves.
  • People with certain medical conditions: People with certain medical conditions, such as rheumatoid arthritis, lupus, and inflammatory bowel disease, are more likely to need oral corticosteroids and are therefore at increased risk of bone loss.

This cohort study delves into the nuanced relationship between oral corticosteroid prescription patterns, fracture preventive care, and the associated outcomes among older individuals with eczema, asthma, or COPD in two separate populations: the United Kingdom and Ontario, Canada.

Methods

The study employed a cohort design and included participants with eczema, asthma, or COPD who were prescribed oral corticosteroids at or above a 450-mg prednisolone equivalent dose within a six-month period. The prescription patterns were categorized into high-intensity and low-intensity groups, and their correlation with the provision of fracture preventive care was explored.

Fracture preventive care encompassed interventions like dual-energy X-ray absorptiometry (DEXA) scans and prescription of medications to enhance bone health.

Results

The findings of the study highlighted a significant association between oral corticosteroid prescription patterns and the likelihood of receiving fracture preventive care. Individuals with high-intensity prescription patterns were more inclined to receive fracture preventive care than those with low-intensity patterns. This trend was consistent across the UK and Ontario cohorts, suggesting a robust relationship.

Among individuals with eczema, the UK cohort demonstrated a remarkable increase in the rate of fracture preventive care prescribing, while the Ontario cohort did not exhibit the same effect. This discrepancy could potentially be attributed to differences in healthcare settings and primary vs. secondary/tertiary care management approaches.

Discussion

The research addresses a critical gap in existing literature by investigating the association between oral corticosteroid prescription patterns and fracture preventive care, independent of cumulative dosage. The study’s methodology, focusing on individuals crossing a specific prednisolone equivalent dose threshold, allows for a comprehensive exploration of this relationship.

The observed disparity in fracture preventive care rates between the UK and Ontario cohorts underscores the importance of healthcare settings and management approaches. The elevated fracture preventive care rate observed in the UK, especially among eczema patients, might be attributed to more comprehensive longitudinal eczema treatment management in secondary or tertiary care compared to primary care.

Implications

This study holds significant implications for clinicians and specialists treating patients with eczema, asthma, or COPD.

Dermatologists, in particular, need to be vigilant about minimizing oral corticosteroid prescriptions due to their adverse effects on bone health.

The prevalence of oral corticosteroid use, even in conditions like eczema where they are not generally recommended, necessitates a proactive approach by healthcare professionals. Collaborative efforts between specialists and primary care teams can enhance patient care by ensuring timely fracture preventive interventions.

Conclusion

This cohort study sheds light on the complex interplay between oral corticosteroid prescription patterns, fracture preventive care, and associated outcomes among individuals with eczema, asthma, or COPD.

The findings underscore the significance of considering prescription intensity in relation to fracture prevention, highlighting the need for comprehensive clinical decision support systems that account for cumulative dosage.

Moreover, the differences observed between the UK and Ontario cohorts emphasize the role of healthcare settings in shaping fracture preventive care rates. Moving forward, this study encourages further research into fracture preventive care prescribing practices in different countries and healthcare settings, providing valuable insights for optimizing patient care and bone health outcomes.


reference link :https://jamanetwork.com/journals/jamadermatology/fullarticle/2808310

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