ORIGINAL ARTICLE An observational study of glucocorticoid-induced osteoporosis prophylaxis in a national cohort of male veterans with rheumatoid arthritis L. Caplan & A. E. Hines & E. Williams & A. V. Prochazka & K. G. Saag & F. Cunningham & E. Hutt Received: 6 August 2009 / Accepted: 25 January 2010 / Published online: 1 April 2010 # International Osteoporosis Foundation and National Osteoporosis Foundation 2010 Abstract Summary We applied regression techniques to a large cohort of patients to understand why certain patients are prescribed medications to prevent glucocorticoid-induced osteoporosis (GIO). Rates of prescriptions to prevent osteoporosis were low. The presence of drugs and disorders associated with osteoporosis and gastrointestinal conditions actually are associated with a decreased likelihood of receiving osteoporosis-preventing medications. Introduction To understand why some patients are prescribed medications to prevent GIO while other patients are not, we examined whether there is an association among osteoporosis- inducing medical conditions or medications and prescriptions for osteoporosis prophylaxis in a large cohort of rheumatoid arthritis patients on chronic glucocorticoids. Methods Department of Veterans’ Affairs national adminis- trative databases were used to construct a cohort (n =9,605) and provide the data for this study. Multivariate logistic regression was performed to determine medical conditions and medications associated with dispensing of GIO- preventive medications, controlling for sociodemographic variables, comorbidities, glucocorticoid dosage, prior frac- tures, and rheumatoid arthritis severity. A subanalysis examined predictors of early GIO prevention. Results Subjects were more likely to receive GIO prophy- laxis if they were older, African American, treated with multiple antirheumatic disease-modifying drugs, or re- ceived greater glucocorticoid exposure. The prescription of certain drug classes (loop diuretics and anticonvulsants) and conditions (malignancy, renal insufficiency, alcohol abuse, and hepatic disease) were associated with lower likelihood of GIO prophylaxis, despite putative links between these agents/conditions and osteoporosis. The presence of gastrointestinal disorders dramatically de- creased likelihood of GIO prophylaxis. Few characteristics predicted the dispensing of GIO-preventing medications within 7 days of the initial glucocorticoid start date. Conclusions Rates of prescriptions to prevent osteoporosis in a cohort of older men with rheumatoid arthritis on chronic glucocorticoids were low. Gastrointestinal disorders The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. L. Caplan : A. E. Hines : E. Williams : A. V. Prochazka : E. Hutt Denver VA Medical Center, 1055 Clermont St, Research 151, Denver, CO 80220, USA L. Caplan : A. V. Prochazka : E. Hutt University of Colorado School of Medicine, Denver, CO, USA K. G. Saag Center for Education and Research on Therapeutics of Musculoskeletal Disorders, University of Alabama at Birmingham, FOT 840, 510 20th Street South, Birmingham, AL 35294, USA K. G. Saag University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA F. Cunningham Veterans Affairs Pharmacy Benefits Management, M/S 119D, Building 37, Room 139, Hines, IL 60141, USA L. Caplan (*) University of Colorado Denver, P.O. Box 6511, B115, Denver, CO 80045, USA e-mail: liron.caplan@ucdenver.edu Osteoporos Int (2011) 22:305–315 DOI 10.1007/s00198-010-1201-x