TY - JOUR T1 - The Disconnect Between Better Quality of Glucocorticoid-induced Osteoporosis Preventive Care and Better Outcomes: A Population-based Cohort Study JF - The Journal of Rheumatology JO - J Rheumatol DO - 10.3899/jrheum.130041 SP - jrheum.130041 AU - Sumit R. Majumdar AU - Lisa M. Lix AU - Suzanne N. Morin AU - Marina Yogendran AU - Colleen J. Metge AU - William D. Leslie Y1 - 2013/07/01 UR - http://www.jrheum.org/content/early/2013/06/27/jrheum.130041.abstract N2 - Objective The quality of glucocorticoid-induced osteoporosis (GIOP) care [defined by bone mineral density (BMD) testing or osteoporosis treatment] is suboptimal and has been targeted for improvement. The assumption that improvements in GIOP preventive care will lead to better outcomes has not been tested. Methods We used linked healthcare databases to conduct a population-based study of all adults 20 years of age or older in Manitoba, Canada, who initiated longterm (> 90 days) systemic glucocorticoids (GC) between 1998 and 2008. High-quality GIOP care was defined by BMD testing or prescription osteoporosis treatment within 6 months. Outcomes were adjusted odds of major fractures within 1 year and 3 years. Results We studied 15,285 subjects who had just begun to take GC; 5804 (38%) were 70 years of age or older, 9185 (58%) were women, and 4755 (30%) received 10 mg or more prednisone equiva - lents daily. Overall, 3898 (25%) subjects received a BMD test or osteoporosis treatment within 6 months. Within 1 year of starting GC, there had been 206 major fractures (1%) and within 3 years, 553 major fractures (4%). High-quality GIOP preventive care was not associated with a reduced risk of major fractures within 1 year (adjusted OR 1.6, 95% CI 1.2–2.1) or within 3 years (adjusted OR 1.3, 95% CI 1.1–1.6). Conclusion Three-quarters of those initiating GC received suboptimal osteoporosis care. Conventional administrative database analyses could not demonstrate that better GIOP preventive care was associated with reductions in medically attended fractures. Clinically rich databases and different analytic techniques are needed to better evaluate the effectiveness of GIOP preventive care. ER -