Long‐term prednisone users are at high risk of bone loss resulting in osteoporosis and fractures. In 2001, the American College of Rheumatology (ACR) recommended initiating bisphosphonate (BP) therapy in patients beginning glucocorticoid (GC) therapy (dose equivalent to prednisone ≥5 mg/day) with treatment duration anticipated to be ≥3 months. This study determined the prevalence of BP use among long‐term GC users in a large database of healthcare claims from more than 50 large employers in the US. This retrospective study was conducted using 2001 to Quarter 1 2004 data from the Medstat MarketScan Commercial and Medicare databases. Patients aged ≥21 years with ≥1 oral GC pharmacy claim in 2002 or later and an average daily GC dose of ≥5.0 mg/day were identified as GC users. Incident GC users were defined as individuals who had 6 months without a GC prescription followed by ≥24 months continuous enrollment. Long‐term GC users were defined as individuals with ≥3 months of GC use. BP use was defined as ≥1 pharmacy claim for BP within the GC‐use period. In the database, 25,934 individuals were identified as incident GC users, which projects to a US employer‐insured prevalence of approximately 10 million. Of these incident users, 6.3% (∼630,000 people) used GCs longer than 3 months. Of the long‐term GC users, 50.5% were female and the average age was 53.2 years. Overall, 79.3% of long‐term GC users never used a BP during their period of GC use. This percentage varied by duration of GC use. Among those using GCs 3‐12 months, 93.3% never used BPs; among 12–24 month GC users, 81.5% never used BPs, and among 24–36 month GC users, 75.8% never used BPs. Among 24–36 month GC users, only 10% used BPs for ≥24 months. While older individuals were somewhat more likely to use BPs, only 29% of long‐term GC users age 65 or older used BPs. Among men with long‐term GC use, 85% never used a BP. In addition, higher GC doses seemed to correlate with decreased prevalence of BP use. Low penetrance of BP use is apparent in those the ACR defines as long‐term glucocorticoid users, despite their elevated risk for osteoporosis. This low penetrance is especially evident among men and in populations with compounded risk, such as the elderly and in subjects with increasingly higher GC doses. Whether this is because of low rates of BP prescribing or poor persistence with BP therapy is uncertain. The potential impact on fractures and health care costs can have important public health implications.
