TY - JOUR T1 - Challenges in Defining Quality of Care for Glucocorticoid-induced Osteoporosis: Defending Good Against Perfect JF - The Journal of Rheumatology JO - J Rheumatol SP - 1640 LP - 1642 DO - 10.3899/jrheum.130980 VL - 40 IS - 10 AU - KENNETH G. SAAG AU - JEFFREY CURTIS AU - AMY WARRINER Y1 - 2013/10/01 UR - http://www.jrheum.org/content/40/10/1640.abstract N2 - In an era of increasing preventive care complexity coupled with progressively shorter doctor visits, asymptomatic conditions such as osteoporosis (OP) can easily be neglected. Despite a reported reduction in fracture burden in the United States and Canada1,2, OP continues to be a condition that is both underdiagnosed and undertreated. In the United States, the Healthcare Effectiveness Data and Information Set statistics from the National Committee on Quality Assurance estimates that less than 25% of persons who incur fracture receive a bone-specific medication; a proportion that has remained essentially stagnant over the past 10 years. These US findings are quite similar to the low rates of OP treatment in Canada, as highlighted in the paper in this issue of The Journal by Majumdar and colleagues3. Glucocorticoids constitute the most commonly administered drugs that are associated with bone loss and higher fracture risk. Despite a clear time- and dose-dependent association of glucocorticoids with fracture risk4,5 and international guidelines that support a variety of pharmacotherapies for both primary and secondary prevention6,7,8,9, the prevention and treatment statistics are also rather dismal for glucocorticoid-induced OP (GIOP). Curtis and colleagues observed temporal improvement in the rates of treatment with nonestrogen bone-acting agents among chronic glucocorticoid users of an Aetna managed-care plan over a 5- to 6-year period10. However, even among postmenopausal women, the group at highest fracture risk, less than two-thirds were being treated in the early 2000s. Majumdar and colleagues, using much newer data from Canada, reported that only 25% of over 15,000 older adults receiving supraphysiologic prednisone were managed in accord with the latest guidelines. Thus, an underuse gap persists for GIOP prevention and treatment.Underuse of many evidence-based therapeutics for chronic conditions such as … Address correspondence to Dr. Saag, 1720 2nd Avenue South, Birmingham, AL 35294, USA. E-mail: Ksaag{at}uab.edu ER -