University of North Carolina, Chapel Hill, and Cleveland Clinic Foundation, Cleveland, Ohio.
Arthritis Care Res (Hoboken). 2014 Nov;66(11):1644-52. doi: 10.1002/acr.22346.
The American College of Rheumatology (ACR) updated its guidelines on the prevention and treatment of glucocorticoid-induced osteoporosis (GIO) in 2010. An unknown proportion of US adults at risk of fracture due to glucocorticoid use would be recommended antiosteoporosis pharmaceutical (AOP) therapies based on the ACR guidelines.
Using the 2005-2010 National Health and Nutrition Examination Survey (NHANES) data for postmenopausal women (PMW), and men age ≥50 years reporting current glucocorticoid use, we categorized individuals according to ACR criteria for low, medium, and high fracture risk (<10%, ≥10%, and ≥20%, respectively) and provided percentages of treatment recommendations for chronic (≥90 days) medium and all high-risk patients.
Glucocorticoids were used by 1.66% of PMW and 1.65% of men age ≥50 years. Of these patients, 0.80% of PMW and 0.45% of men age ≥50 years were at high risk of fracture. A majority of PMW (81.2%) and men age ≥50 years (75.8%) were chronic glucocorticoid users. In patients for whom treatment recommendations could be made, 64.9% of PMW and 51.9% of men age ≥50 years would be recommended therapy, but only 28.4% of PMW and 9.7% of men age ≥50 years reported AOP use.
Based on the NHANES (2005-2010) data, we estimate glucocorticoid use in >1.5 million US PMW and men age ≥50 years. Treatment would be recommended in at least 50% of this population based on the 2010 ACR guidelines. Self-reported AOP use was documented in <30%, suggesting a treatment gap in the management of GIO in the US before the guideline release.
美国风湿病学会（ACR）于 2010 年更新了糖皮质激素性骨质疏松症（GIO）预防和治疗指南。根据 ACR 指南，美国有相当比例的因使用糖皮质激素而面临骨折风险的成年人会被推荐使用抗骨质疏松药物（AOP）治疗。
我们使用 2005-2010 年全国健康与营养调查（NHANES）中报告当前正在使用糖皮质激素的绝经后女性（PMW）和年龄≥50 岁的男性的数据，根据 ACR 标准将个体分为低、中、高骨折风险人群（分别为<10%、≥10%和≥20%），并提供慢性（≥90 天）中危和所有高危患者的治疗推荐比例。
PMW 中有 1.66%和年龄≥50 岁的男性中有 1.65%使用糖皮质激素。这些患者中，PMW 中有 0.80%和年龄≥50 岁的男性中有 0.45%有高骨折风险。大多数 PMW（81.2%）和年龄≥50 岁的男性（75.8%）是慢性糖皮质激素使用者。在可以给出治疗建议的患者中，PMW 中有 64.9%和年龄≥50 岁的男性中有 51.9%会被推荐治疗，但 PMW 中有 28.4%和年龄≥50 岁的男性中有 9.7%报告使用了 AOP。
根据 NHANES（2005-2010）数据，我们估计有超过 150 万美国 PMW 和年龄≥50 岁的男性正在使用糖皮质激素。根据 2010 年 ACR 指南，该人群中至少有 50%需要治疗。但自我报告的 AOP 使用不到 30%，表明在该指南发布之前，美国 GIO 的管理存在治疗缺口。
