Systematic review of trends in prophylaxis of corticosteroid-induced osteoporosis

The need for standard audit guidelines

M. Duyvendak, M. Naunton, E. N. Van Roon, G. A.W. Bruyn, J. R.B.J. Brouwers

Research output: Contribution to journalArticle

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Abstract

Summary: Corticosteroid-induced osteoporosis (CIOP) is currently undertreated. Systematic review of the literature revealed that the percentage of patients treated adequately is dependent on study quality. Therefore, it remains unknown whether adherence to the guidelines is really so poor. Five major quality criteria provide the standard for future studies on this scope. Introduction: It has recently been stated that the degree of prophylaxis of corticosteroid-induced osteoporosis (CIOP) is low and effort should be put into determining reasons for non-prescribing of preventive agents. The aim of this study was to identify: how many studies adequately audit the prevalent guideline; the longitudinal trends in prevention of CIOP; which patient groups appear to be most undertreated; and which intervention strategies are effective. Methods: We performed a comprehensive search of MEDLINE and systematically recorded the outcomes and quality of published studies, using five major criteria. Results: Twenty-four studies were included in the analysis. The quality of the included studies was poor (31%) or moderate (37%). There was a longitudinal increase in quality of the studies and percentage of prevention. Multivariable linear regression showed that the quality of the study was the only independent predictor of the prevention rate reported in the study. Conclusions: The results show undertreatment of CIOP might be due to insufficient quality of the studies rather than poor practice or failure to recognise the right patients. Future interventions should comply with five major quality criteria, and a multifaceted approach is required in order to make an impact on the underprescribing of CIOP prophylaxis.

Original languageEnglish
Pages (from-to)1379-1394
Number of pages16
JournalOsteoporosis International
Volume19
Issue number10
DOIs
Publication statusPublished - 1 Oct 2008
Externally publishedYes

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Osteoporosis
Adrenal Cortex Hormones
Guidelines
Guideline Adherence
Patient Rights
MEDLINE
Linear Models

Cite this

Duyvendak, M. ; Naunton, M. ; Van Roon, E. N. ; Bruyn, G. A.W. ; Brouwers, J. R.B.J. / Systematic review of trends in prophylaxis of corticosteroid-induced osteoporosis : The need for standard audit guidelines. In: Osteoporosis International. 2008 ; Vol. 19, No. 10. pp. 1379-1394.
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Systematic review of trends in prophylaxis of corticosteroid-induced osteoporosis : The need for standard audit guidelines. / Duyvendak, M.; Naunton, M.; Van Roon, E. N.; Bruyn, G. A.W.; Brouwers, J. R.B.J.

In: Osteoporosis International, Vol. 19, No. 10, 01.10.2008, p. 1379-1394.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Systematic review of trends in prophylaxis of corticosteroid-induced osteoporosis

T2 - The need for standard audit guidelines

AU - Duyvendak, M.

AU - Naunton, M.

AU - Van Roon, E. N.

AU - Bruyn, G. A.W.

AU - Brouwers, J. R.B.J.

PY - 2008/10/1

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N2 - Summary: Corticosteroid-induced osteoporosis (CIOP) is currently undertreated. Systematic review of the literature revealed that the percentage of patients treated adequately is dependent on study quality. Therefore, it remains unknown whether adherence to the guidelines is really so poor. Five major quality criteria provide the standard for future studies on this scope. Introduction: It has recently been stated that the degree of prophylaxis of corticosteroid-induced osteoporosis (CIOP) is low and effort should be put into determining reasons for non-prescribing of preventive agents. The aim of this study was to identify: how many studies adequately audit the prevalent guideline; the longitudinal trends in prevention of CIOP; which patient groups appear to be most undertreated; and which intervention strategies are effective. Methods: We performed a comprehensive search of MEDLINE and systematically recorded the outcomes and quality of published studies, using five major criteria. Results: Twenty-four studies were included in the analysis. The quality of the included studies was poor (31%) or moderate (37%). There was a longitudinal increase in quality of the studies and percentage of prevention. Multivariable linear regression showed that the quality of the study was the only independent predictor of the prevention rate reported in the study. Conclusions: The results show undertreatment of CIOP might be due to insufficient quality of the studies rather than poor practice or failure to recognise the right patients. Future interventions should comply with five major quality criteria, and a multifaceted approach is required in order to make an impact on the underprescribing of CIOP prophylaxis.

AB - Summary: Corticosteroid-induced osteoporosis (CIOP) is currently undertreated. Systematic review of the literature revealed that the percentage of patients treated adequately is dependent on study quality. Therefore, it remains unknown whether adherence to the guidelines is really so poor. Five major quality criteria provide the standard for future studies on this scope. Introduction: It has recently been stated that the degree of prophylaxis of corticosteroid-induced osteoporosis (CIOP) is low and effort should be put into determining reasons for non-prescribing of preventive agents. The aim of this study was to identify: how many studies adequately audit the prevalent guideline; the longitudinal trends in prevention of CIOP; which patient groups appear to be most undertreated; and which intervention strategies are effective. Methods: We performed a comprehensive search of MEDLINE and systematically recorded the outcomes and quality of published studies, using five major criteria. Results: Twenty-four studies were included in the analysis. The quality of the included studies was poor (31%) or moderate (37%). There was a longitudinal increase in quality of the studies and percentage of prevention. Multivariable linear regression showed that the quality of the study was the only independent predictor of the prevention rate reported in the study. Conclusions: The results show undertreatment of CIOP might be due to insufficient quality of the studies rather than poor practice or failure to recognise the right patients. Future interventions should comply with five major quality criteria, and a multifaceted approach is required in order to make an impact on the underprescribing of CIOP prophylaxis.

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KW - Corticosteroid

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KW - Osteoporosis

KW - Prophylaxis

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JO - Osteoporosis International

JF - Osteoporosis International

SN - 0937-941X

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ER -