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

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.

Figure 1.

Annual prevalence of prescriptions of different GCS medications per year and the total prescription prevalence of all GCS in Iceland from 2003 to 2020.

Figure 2.

Prevalence of males and females receiving GCS prescriptions for oral use per year (2003–2020).

Figure 3.

Prevalence of those who received oral GCS by age group from 2003 to 2020.

Figure 4.

Prevalence of total users of oral GCS and prevalence of those that receive >90 DDDs of GCS each year.

Figure 5.

Percentage of those defined as chronic users that also receive bisphosphonates within 90 days of prescription of GCS, each year from 2003 to 2020.

Figure 6.

The total prescription prevalence of bone protective medications in Iceland over 17 years (2003–2020) and annual prevalence of different bone protective medications per year.