Nationwide prevalence of glucocorticoid prescriptions over 17 years and osteoporosis prevention among long-term users

Hulda Hrund Bjornsdottir; Ólafur Brynjólfur Einarsson; Gerdur Gröndal; Bjorn Gudbjornsson

doi:10.1177/20503121241235056

Nationwide prevalence of glucocorticoid prescriptions over 17 years and osteoporosis prevention among long-term users

SAGE Open Med. 2024 Mar 20:12:20503121241235056. doi: 10.1177/20503121241235056. eCollection 2024.

Authors

Hulda Hrund Bjornsdottir¹, Ólafur Brynjólfur Einarsson², Gerdur Gröndal^{3

4}, Bjorn Gudbjornsson^{4

5}

Affiliations

¹ Department of Medicine, Landspitali University Hospital of Iceland, Reykjavik, Iceland.
² The Icelandic Prescription Medicines Registers, Director of Health, Reykjavik, Iceland.
³ Department of Rheumatology, Landspitali University Hospital of Iceland, Reykjavik, Iceland.
⁴ Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
⁵ Centre for Rheumatology Research, Landspitali University Hospital of Iceland, Reykjavik, Iceland.

Abstract

Objectives: Glucocorticoid steroids are frequently prescribed, and side effects are well-known, such as glucocorticoid-induced osteoporosis. Our aim was to estimate the nationwide trend in the prevalence of glucocorticoid steroid prescriptions over 17 years and to elucidate the proportion of patients on long-term glucocorticoid steroid therapy who receive active bone protective therapy. As well as to examine which medical specialties prescribe glucocorticoid steroids the most.

Methods: This study was a retrospective observational registry study extended over 17 years (2003-2020). Data were retrieved from the Icelandic Prescription Medicine Register on all delivered glucocorticoid steroids (Anatomic therapeutic chemical code: H02AB) for oral use. Long-term users were defined as those who annually received ⩾90 defined daily doses of glucocorticoid steroids.

Results: Annually, 3.8% of the population received oral glucocorticoid steroids, from 3.3% in 2006 to 4.3% in 2017. Prednisolone was most frequently prescribed. Females dispatched glucocorticoid steroid prescriptions more often than males (55.8%). Males and females reached their peak prevalence between the ages of 60 and 70. General practitioners most often prescribe glucocorticoid steroids, followed by physicians in training, rheumatologists, internists, and medical students. Of those who received prescriptions for glucocorticoid steroids, 12.2%-18.1% were classified as long-term users. A declining number of patients have been receiving bone-protective therapy in recent years. Only 13.0% of chronic users received bone protective therapy in 2020.

Conclusion: The use of glucocorticoid steroids has increased during the last 2 decades despite improvements in treatment for inflammatory disorders. The prevalence of long-term users has remained stable. Meanwhile, the use of parallel active bone-protective therapy among long-term users of glucocorticoid steroids is declining. Thus, improvements in prophylaxis for corticosteroid-induced osteoporosis are urgently needed for patients who require long-term treatment with glucocorticoid steroids.

Keywords: Glucocorticoids; bone protective treatment; nationwide; observational registry study; osteoporosis.