Suboptimal osteoporosis screening rates persist in patients on long-term glucocorticoid therapy: current experience within an academic health system

• Only 15% of patients are screened for glucocorticoid-induced osteoporosis despite guidelines. • Screening is more common in older, White, and female patients • Greater comorbidity burden is associated with higher screening rates. • Screening may improve by targeting subpopulations with low screening rates. • Clarifying specialty-specific practice variations may further improve screening. Glucocorticoid-induced osteoporosis (GIO) is a serious complication of long-term glucocorticoid therapy. Although the risks of glucocorticoid therapy are well recognized, screening rates for GIO are low. This study aimed to evaluate the current state of GIO screening in patients treated with long-term glucocorticoids and the factors associated with higher screening rates. We conducted a retrospective cohort study of 8923 patients ≥ 40 years who received long-term glucocorticoid therapy (≥2.5 mg prednisone daily or equivalent dose for ≥ 3 months) within the M Health Fairview health system from 2017 to 2022. Demographics, comorbidities, and dual-energy x-ray absorptiometry (DXA) screening data were extracted from the electronic health record and analyzed. We identified factors associated with DXA screening by logistic regression analysis. 15.4% of patients received DXA screening within 2 years before and 1 year after glucocorticoid initiation. 3.8% of patients were screened within 6 months of starting treatment. Factors significantly associated with DXA screening included female sex (OR 2.51, 2.16–2.91, p < 0.001), greater age (OR 1.02, 1.01–1.02, p < 0.001), White race (OR 1.71, p < 0.001), and the presence of additional comorbidities (OR 1.84, 1.74–1.93, p < 0.001). Screening for GIO in high-risk patients remains suboptimal, despite longstanding efforts at increasing awareness of this condition. Factors such as older age, female sex, White race, and higher comorbidity burden were associated with increased screening. Our findings highlight that interventions to date have been insufficient in improving GIO screening and that novel approaches are needed to make a meaningful change in longstanding low screening rates.