Glucocorticoid-Induced Osteoporosis Program (GIOP) 

Background

• Glucocorticoids (GC) can have a profound effect on bone loss
  • Osteoblastic bone formation is decreased
  • Osteoblast function and lifespan is decreased
  • Osteoclastic bone resorption is increased
  • decrease in sex hormones
  • increase in PTH (from decrease in GI calcium absorption and increase in urinary calcium excretion)
• Up to 50% of patients on chronic GC will sustain an osteoporotic fracture
• Doses as low as 2.5-5 mg daily have been associated with an increased fracture risk

Assessment of the GC Problem

• Baseline assessment in 2000-2001 – poor rate of testing and treatment
• Education to specialists in 2002-2003 – no change in intervention rate
• 2003-2004 – change in DXA-based recommendations resulted in higher treatment rates of at-risk patients, but no change in rate of testing

Solution – GIOP - an organized program of care for patients on chronic GC

• GIOP Goals – identify at risk patients, educate, develop and implement pathways to improve diagnosis and treatment, monitor outcomes
• GIOP Offers – consultation only, or consultation and treat (including education, risk assessment, diagnosis, treatment, monitoring, and communication with referring physician)

GIOP Outcomes

• Over 200 patients in the program
• Baseline
• mean age 63 years, 70% women, 78% vitamin D insufficient
• 69% of patients at high risk of future fracture
• Follow-up at 6 months and 1 year
• Significant improvement in knowledge, exercise
• Significant improvement in Vitamin D levels
• Treatment rate and adherence to medication regimen excellent

GIOP Information for Patients

• Call 1-800-275-6410 and say “Gee-op” to find out more about the program and to enter a patient

GIOP Physician Referral - Any physician can refer a patient

• Geisinger Physican - in EPIC, under orders, type “GIOP” and a GIOP-specific consult form will appear
• Non-Geisinger Physician - Call 1-800-332-8901 and say “Gee-op” – to be transferred to a MedLink Staff Nurse  to find out more about the program and enter a patient

References

Newman ED, Ayoub WT, Wood C: Glucocorticoid-induced osteoporosis – demographic analysis of at risk patients, diagnosis, and treatment in a rural primary care population.  Arthritis Rheum 2001:44(9):S314.
 
Newman ED, Ayoub WT, Matzko CK, Wood C.  Glucocorticoid-induced osteoporosis – significant improvement in bisphosphonate use utilizing standardized consultative DXA reporting.  Arthritis Rheum 2003:48:S499.

Newman ED, Matzko CK, Olenginski TP, Perruquet JL, Harrington TM, Wood GC, Culp T.  Glucocorticoid-induced osteoporosis program – comprehensive care with improved outcomes after 6 months.  Arthritis Rheum 2005:52(9):S408.