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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.