3-Year Results of a Member and Physician Intervention to Reduce Risk Associated With Glucocorticoid-Induced Osteoporosis in a Health Plan

BACKGROUND: Accelerated bone loss is a well-known outcome of chronic treatment with glucocorticoids, making glucocorticoid-induced osteoporosis a significant cause of morbidity and a burden on health care resources. Recommendations for prevention and treatment of glucocorticoid-induced osteoporosis include therapy with a bisphosphonate or calcitonin for patients taking a prednisone equivalent of 5 mg per day or more for 3 months or more. OBJECTIVES: To evaluate the effects of a targeted member and physician educational intervention on the use of anti-osteoporotic drug therapy in patients using chronic oral glucocorticoid therapy. METHODS: Pharmacy claims were analyzed for a 4-month period in each of 3 years, for claims with dates of service from April 1 through July 30, 2003,May 1 through August 31, 2004, and February 4 through May 5, 2005, to identify all adult members of a health plan of approximately 1.3 million members who received an oral glucocorticoid (e.g., prednisone, dexamethasone) for at least 90 of 120 days (chronic use) and did not receive a medication for osteoporosis prevention (e.g., risedronate, ibandronate, etidronate, raloxifene, alendronate, calcitonin) during the same 120-day time period. The intervention involved direct-to-patient mailing of a cover letter and a 2-page educational brochure, and a physician mailing that included the same 2-page educational brochure, a 1-page table of recommended drug therapies for prevention of osteroporosis, and an invitation for physicians to request by fax-back a list of at-risk patients. Follow-up claims analyses were conducted for 120 days after each of the 3 intervention periods to determine the number and percentage of target patients who were initiated and maintained on a medication to prevent osteoporosis. RESULTS: The prevalence of health plan members at risk of glucocorticoid induced osteoporosis was 0.28% in 2003, 0.29% in 2004, 0.29% in 2005, and 0.29% during the 3 years combined. Approximately 47.5% of patients (n = 5,140) during the 3-year period who received chronic glucocorticoids also received drug therapy for prevention or treatment of osteoporosis. Women made up 59.6% (6,450/10,822) of patients who received chronic glucocorticoid therapy during the 3 years; 50.9% (3,285/6,450) of the female patients, and 54.8% (2,397/4,372) of the male patients on chronic glucocorticoid therapy were at risk because of the absence of preventive therapy with an anti-osteoporosis medication. During the 3 years, 404 (7.1%) of the total 5,682 male and female patients at risk because of chronic glucocorticoid therapy and who were the subjects of the educational intervention were started on an osteoporosis medication following the mailings. Of these, 84.9% (343/404) continued on both the glucocorticoid therapy and an anti-osteoporosis medication in the subsequent 4-month follow-up period. During the 3 years, only 4.9% of targeted physicians (n = 196), affecting 6.8% of at-risk patients (n=387), requested a list of their patients at risk via the fax-back opportunity. CONCLUSIONS: A simple intervention program that screened at-risk patients and reached out to these patients and their physicians via a target-mailing intended to reduce the risk of glucorticoid-induced osteoporosis was associated with a modest increase in the proportion of at-risk patients receiving preventive drug therapy for osteoporosis.