Doctors’ beliefs and knowledge on corticosteroid-induced osteoporosis: identifying barriers to improve prevention
Version of Record online: 19 OCT 2010
© 2010 Blackwell Publishing Ltd
Journal of Clinical Pharmacy and Therapeutics
Volume 36, Issue 3, pages 356–366, June 2011
How to Cite
Duyvendak, M., Naunton, M., van Roon, E. N. and Brouwers, J. R. B. J. (2011), Doctors’ beliefs and knowledge on corticosteroid-induced osteoporosis: identifying barriers to improve prevention. Journal of Clinical Pharmacy and Therapeutics, 36: 356–366. doi: 10.1111/j.1365-2710.2010.01185.x
- Issue online: 5 MAY 2011
- Version of Record online: 19 OCT 2010
- Received 22 August 2009, Accepted 19 April 2010
- bone mineral density;
What is known and Objective: Despite the availability of effective treatments for the management of corticosteroid-induced osteoporosis (CIOP), the condition is undertreated. Our objective was to assess prescribers’ knowledge and likely prescribing patterns concerning the diagnosis and treatment of CIOP. Another goal was to identify key barriers to the use of preventive therapy in patients using long-term corticosteroids.
Methods: We used a postal survey of general practitioners (GPs) and specialists in the Netherlands. The survey comprised of questions on: demographic data, perceived barriers to the use of preventive therapy for CIOP, and knowledge of diagnosis and treatment of CIOP. Case scenarios were questioned to assess practice patterns.
Results: Responding prescribers correctly answered an average of 55% of knowledge questions and 69% of case scenarios. Multiple questions and cases showed that knowledge on the use of bone mineral density (BMD) determination was poor. BMD was determined in patients who, according to the national osteoporosis guideline, should be treated with bisphosphonates independent of BMD. Moreover, only 18% of doctors correctly answered that the BMD cutoff in CIOP patients is a T-score of ≤−1 or ≤−1·5. Key barriers identified were: (i) GPs, significantly more than specialists, consider prescription of preventive therapy the responsibility of another doctor; (ii) discontinuation of anti-resorptive medication due to adverse effects and (iii) the reluctance to prescribe preventive therapy in patients already prescribed multiple medications.
What is new and Conclusion: Doctors did not identify many barriers to the prescribing of anti-resorptive therapies. Lack of knowledge, especially concerning use of BMD-results, likely led to the under-treatment of the presented patients.