Fracture rate associated with quality metric-based anti-osteoporosis treatment in glucocorticoid-induced osteoporosis
Summary Anti-osteoporosis medication (AOM) use in patients exposed to glucocorticoids is thought to reduce fractures. We found post-menopausal women using glucocorticoids for at least 90 days who also used an AOM within 90 days had 48 % fewer fractures by 1 year and 32 % fewer fractures by 3 years c...
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| Veröffentlicht in: | Osteoporosis international 2015-05, Vol.26 (5), p.1515-1524 |
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| creator | Overman, R. A. Gourlay, M. L. Deal, C. L. Farley, J. F. Brookhart, M. A. Layton, J. B. |
| description | Summary
Anti-osteoporosis medication (AOM) use in patients exposed to glucocorticoids is thought to reduce fractures. We found post-menopausal women using glucocorticoids for at least 90 days who also used an AOM within 90 days had 48 % fewer fractures by 1 year and 32 % fewer fractures by 3 years compared to non-AOM users.
Introduction
The purpose of this study is to explore the effectiveness of adherence to quality measures by estimating the effect of anti-osteoporosis medication (AOM) initiation within 90 days after chronic (≥90 days) glucocorticoid (GC) therapy on osteoporotic fracture.
Methods
A new-user cohort was assembled using the MarketScan databases between 2000 and 2012. Included patients were female, age ≥50 at GC initiation, had a first GC fill daily dose ≥10 mg and persisted for at least 90 days. During a 365-day baseline period, patients were excluded for prior GC or AOM (bisphosphonate, denosumab, teriparatide) use, fracture, or cancer diagnosis. Initiators of an AOM in the 14 days pre- or 90 days post-GC fill were characterized as AOM users; those without, AOM non-users. Follow-up began 91 days after GC fill with patients followed until fracture, loss of continuous enrollment, initiation of AOM by AOM non-users, or end of study period. A propensity score was estimated for AOM receipt using all measured covariates and converted to a stabilized inverse probability of treatment weights (IPTW). Weighted hazard ratios (HR) and associated 95 % confidence intervals (95 % CI) were estimated using weighted Cox proportional hazard models.
Results
Of the 7885 women eligible for the study, 12.1 % were AOM users. AOM use was associated with lower fracture incidence: weighted HR of 0.52 (95 % CI 0.29, 0.94) at 1 year and weighted HR of 0.68 (95 % CI 0.47, 0.99) at 3 years.
Conclusions
AOM initiation within 90 days of chronic GC use was associated with a fracture reduction of 48 % at 1 year and 32 % at 3 years. |
| doi_str_mv | 10.1007/s00198-014-3022-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4401629</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3655765191</sourcerecordid><originalsourceid>FETCH-LOGICAL-c573t-12b53dd0998ba6c682af3e3961e0c951f4593fbf16610ff0241b462a564e1eb63</originalsourceid><addsrcrecordid>eNqNkc2KFDEUhYMoTtv6AG6kwI2b6L1JKtXZCDI4Kgy4UXAXUqlUT4aqSk9-RubtTdHj0AqCqwTud07OzSHkJcJbBOjeJQBUOwooKAfGqHpENig4p0zJ9jHZgOIdVQJ_nJFnKV1D1SjVPSVnrJUAohMbUi6isblE10STXWNSCtbX29D89PmquSlm8vmumV2O3tLepDoxS_Y0pOzCIcSQfGpydCbPbsmNX5r9VGywIWZvgx-oX4Ziq-pU8Jw8Gc2U3Iv7c0u-X3z8dv6ZXn799OX8wyW1bcczRda3fBhAqV1vpJU7ZkbuuJLowKoWR9EqPvYjSokwjsAE9kIy00rh0PWSb8n7o--h9LMbbE0YzaQP0c8m3ulgvP5zsvgrvQ-3WghAyVQ1eHNvEMNNcSnr2SfrpsksLpSkUe5AiAqK_0A7wWoDdbMtef0Xeh1KXOpPrBTnCIyv4fFI2fpnKbrxITeCXvvXx_517V-v_es176vThR8UvwuvADsCqY6WvYsnT__T9ReCer4H</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1673310236</pqid></control><display><type>article</type><title>Fracture rate associated with quality metric-based anti-osteoporosis treatment in glucocorticoid-induced osteoporosis</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Overman, R. A. ; Gourlay, M. L. ; Deal, C. L. ; Farley, J. F. ; Brookhart, M. A. ; Layton, J. B.</creator><creatorcontrib>Overman, R. A. ; Gourlay, M. L. ; Deal, C. L. ; Farley, J. F. ; Brookhart, M. A. ; Layton, J. B.</creatorcontrib><description>Summary
Anti-osteoporosis medication (AOM) use in patients exposed to glucocorticoids is thought to reduce fractures. We found post-menopausal women using glucocorticoids for at least 90 days who also used an AOM within 90 days had 48 % fewer fractures by 1 year and 32 % fewer fractures by 3 years compared to non-AOM users.
Introduction
The purpose of this study is to explore the effectiveness of adherence to quality measures by estimating the effect of anti-osteoporosis medication (AOM) initiation within 90 days after chronic (≥90 days) glucocorticoid (GC) therapy on osteoporotic fracture.
Methods
A new-user cohort was assembled using the MarketScan databases between 2000 and 2012. Included patients were female, age ≥50 at GC initiation, had a first GC fill daily dose ≥10 mg and persisted for at least 90 days. During a 365-day baseline period, patients were excluded for prior GC or AOM (bisphosphonate, denosumab, teriparatide) use, fracture, or cancer diagnosis. Initiators of an AOM in the 14 days pre- or 90 days post-GC fill were characterized as AOM users; those without, AOM non-users. Follow-up began 91 days after GC fill with patients followed until fracture, loss of continuous enrollment, initiation of AOM by AOM non-users, or end of study period. A propensity score was estimated for AOM receipt using all measured covariates and converted to a stabilized inverse probability of treatment weights (IPTW). Weighted hazard ratios (HR) and associated 95 % confidence intervals (95 % CI) were estimated using weighted Cox proportional hazard models.
Results
Of the 7885 women eligible for the study, 12.1 % were AOM users. AOM use was associated with lower fracture incidence: weighted HR of 0.52 (95 % CI 0.29, 0.94) at 1 year and weighted HR of 0.68 (95 % CI 0.47, 0.99) at 3 years.
Conclusions
AOM initiation within 90 days of chronic GC use was associated with a fracture reduction of 48 % at 1 year and 32 % at 3 years.</description><identifier>ISSN: 0937-941X</identifier><identifier>EISSN: 1433-2965</identifier><identifier>DOI: 10.1007/s00198-014-3022-9</identifier><identifier>PMID: 25600474</identifier><language>eng</language><publisher>London: Springer London</publisher><subject>Administration, Oral ; Aged ; Aged, 80 and over ; Bone Density Conservation Agents - therapeutic use ; Drug Administration Schedule ; Drug therapy ; Endocrinology ; Female ; Follow-Up Studies ; Fractures ; Glucocorticoids - administration & dosage ; Glucocorticoids - adverse effects ; Humans ; Medicine ; Medicine & Public Health ; Middle Aged ; Original Article ; Orthopedics ; Osteoporosis ; Osteoporosis, Postmenopausal - chemically induced ; Osteoporosis, Postmenopausal - complications ; Osteoporosis, Postmenopausal - drug therapy ; Osteoporotic Fractures - etiology ; Osteoporotic Fractures - prevention & control ; Retrospective Studies ; Rheumatology ; Studies ; Women</subject><ispartof>Osteoporosis international, 2015-05, Vol.26 (5), p.1515-1524</ispartof><rights>International Osteoporosis Foundation and National Osteoporosis Foundation 2015</rights><rights>International Osteoporosis Foundation and National Osteoporosis Foundation 2015 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c573t-12b53dd0998ba6c682af3e3961e0c951f4593fbf16610ff0241b462a564e1eb63</citedby><cites>FETCH-LOGICAL-c573t-12b53dd0998ba6c682af3e3961e0c951f4593fbf16610ff0241b462a564e1eb63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00198-014-3022-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00198-014-3022-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27922,27923,41486,42555,51317</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25600474$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Overman, R. A.</creatorcontrib><creatorcontrib>Gourlay, M. L.</creatorcontrib><creatorcontrib>Deal, C. L.</creatorcontrib><creatorcontrib>Farley, J. F.</creatorcontrib><creatorcontrib>Brookhart, M. A.</creatorcontrib><creatorcontrib>Layton, J. B.</creatorcontrib><title>Fracture rate associated with quality metric-based anti-osteoporosis treatment in glucocorticoid-induced osteoporosis</title><title>Osteoporosis international</title><addtitle>Osteoporos Int</addtitle><addtitle>Osteoporos Int</addtitle><description>Summary
Anti-osteoporosis medication (AOM) use in patients exposed to glucocorticoids is thought to reduce fractures. We found post-menopausal women using glucocorticoids for at least 90 days who also used an AOM within 90 days had 48 % fewer fractures by 1 year and 32 % fewer fractures by 3 years compared to non-AOM users.
Introduction
The purpose of this study is to explore the effectiveness of adherence to quality measures by estimating the effect of anti-osteoporosis medication (AOM) initiation within 90 days after chronic (≥90 days) glucocorticoid (GC) therapy on osteoporotic fracture.
Methods
A new-user cohort was assembled using the MarketScan databases between 2000 and 2012. Included patients were female, age ≥50 at GC initiation, had a first GC fill daily dose ≥10 mg and persisted for at least 90 days. During a 365-day baseline period, patients were excluded for prior GC or AOM (bisphosphonate, denosumab, teriparatide) use, fracture, or cancer diagnosis. Initiators of an AOM in the 14 days pre- or 90 days post-GC fill were characterized as AOM users; those without, AOM non-users. Follow-up began 91 days after GC fill with patients followed until fracture, loss of continuous enrollment, initiation of AOM by AOM non-users, or end of study period. A propensity score was estimated for AOM receipt using all measured covariates and converted to a stabilized inverse probability of treatment weights (IPTW). Weighted hazard ratios (HR) and associated 95 % confidence intervals (95 % CI) were estimated using weighted Cox proportional hazard models.
Results
Of the 7885 women eligible for the study, 12.1 % were AOM users. AOM use was associated with lower fracture incidence: weighted HR of 0.52 (95 % CI 0.29, 0.94) at 1 year and weighted HR of 0.68 (95 % CI 0.47, 0.99) at 3 years.
Conclusions
AOM initiation within 90 days of chronic GC use was associated with a fracture reduction of 48 % at 1 year and 32 % at 3 years.</description><subject>Administration, Oral</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Bone Density Conservation Agents - therapeutic use</subject><subject>Drug Administration Schedule</subject><subject>Drug therapy</subject><subject>Endocrinology</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Fractures</subject><subject>Glucocorticoids - administration & dosage</subject><subject>Glucocorticoids - adverse effects</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Article</subject><subject>Orthopedics</subject><subject>Osteoporosis</subject><subject>Osteoporosis, Postmenopausal - chemically induced</subject><subject>Osteoporosis, Postmenopausal - complications</subject><subject>Osteoporosis, Postmenopausal - drug therapy</subject><subject>Osteoporotic Fractures - etiology</subject><subject>Osteoporotic Fractures - prevention & control</subject><subject>Retrospective Studies</subject><subject>Rheumatology</subject><subject>Studies</subject><subject>Women</subject><issn>0937-941X</issn><issn>1433-2965</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkc2KFDEUhYMoTtv6AG6kwI2b6L1JKtXZCDI4Kgy4UXAXUqlUT4aqSk9-RubtTdHj0AqCqwTud07OzSHkJcJbBOjeJQBUOwooKAfGqHpENig4p0zJ9jHZgOIdVQJ_nJFnKV1D1SjVPSVnrJUAohMbUi6isblE10STXWNSCtbX29D89PmquSlm8vmumV2O3tLepDoxS_Y0pOzCIcSQfGpydCbPbsmNX5r9VGywIWZvgx-oX4Ziq-pU8Jw8Gc2U3Iv7c0u-X3z8dv6ZXn799OX8wyW1bcczRda3fBhAqV1vpJU7ZkbuuJLowKoWR9EqPvYjSokwjsAE9kIy00rh0PWSb8n7o--h9LMbbE0YzaQP0c8m3ulgvP5zsvgrvQ-3WghAyVQ1eHNvEMNNcSnr2SfrpsksLpSkUe5AiAqK_0A7wWoDdbMtef0Xeh1KXOpPrBTnCIyv4fFI2fpnKbrxITeCXvvXx_517V-v_es176vThR8UvwuvADsCqY6WvYsnT__T9ReCer4H</recordid><startdate>20150501</startdate><enddate>20150501</enddate><creator>Overman, R. A.</creator><creator>Gourlay, M. L.</creator><creator>Deal, C. L.</creator><creator>Farley, J. F.</creator><creator>Brookhart, M. A.</creator><creator>Layton, J. B.</creator><general>Springer London</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20150501</creationdate><title>Fracture rate associated with quality metric-based anti-osteoporosis treatment in glucocorticoid-induced osteoporosis</title><author>Overman, R. A. ; Gourlay, M. L. ; Deal, C. L. ; Farley, J. F. ; Brookhart, M. A. ; Layton, J. B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c573t-12b53dd0998ba6c682af3e3961e0c951f4593fbf16610ff0241b462a564e1eb63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Administration, Oral</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Bone Density Conservation Agents - therapeutic use</topic><topic>Drug Administration Schedule</topic><topic>Drug therapy</topic><topic>Endocrinology</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Fractures</topic><topic>Glucocorticoids - administration & dosage</topic><topic>Glucocorticoids - adverse effects</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original Article</topic><topic>Orthopedics</topic><topic>Osteoporosis</topic><topic>Osteoporosis, Postmenopausal - chemically induced</topic><topic>Osteoporosis, Postmenopausal - complications</topic><topic>Osteoporosis, Postmenopausal - drug therapy</topic><topic>Osteoporotic Fractures - etiology</topic><topic>Osteoporotic Fractures - prevention & control</topic><topic>Retrospective Studies</topic><topic>Rheumatology</topic><topic>Studies</topic><topic>Women</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Overman, R. A.</creatorcontrib><creatorcontrib>Gourlay, M. L.</creatorcontrib><creatorcontrib>Deal, C. L.</creatorcontrib><creatorcontrib>Farley, J. F.</creatorcontrib><creatorcontrib>Brookhart, M. A.</creatorcontrib><creatorcontrib>Layton, J. B.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Osteoporosis international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Overman, R. A.</au><au>Gourlay, M. L.</au><au>Deal, C. L.</au><au>Farley, J. F.</au><au>Brookhart, M. A.</au><au>Layton, J. B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Fracture rate associated with quality metric-based anti-osteoporosis treatment in glucocorticoid-induced osteoporosis</atitle><jtitle>Osteoporosis international</jtitle><stitle>Osteoporos Int</stitle><addtitle>Osteoporos Int</addtitle><date>2015-05-01</date><risdate>2015</risdate><volume>26</volume><issue>5</issue><spage>1515</spage><epage>1524</epage><pages>1515-1524</pages><issn>0937-941X</issn><eissn>1433-2965</eissn><abstract>Summary
Anti-osteoporosis medication (AOM) use in patients exposed to glucocorticoids is thought to reduce fractures. We found post-menopausal women using glucocorticoids for at least 90 days who also used an AOM within 90 days had 48 % fewer fractures by 1 year and 32 % fewer fractures by 3 years compared to non-AOM users.
Introduction
The purpose of this study is to explore the effectiveness of adherence to quality measures by estimating the effect of anti-osteoporosis medication (AOM) initiation within 90 days after chronic (≥90 days) glucocorticoid (GC) therapy on osteoporotic fracture.
Methods
A new-user cohort was assembled using the MarketScan databases between 2000 and 2012. Included patients were female, age ≥50 at GC initiation, had a first GC fill daily dose ≥10 mg and persisted for at least 90 days. During a 365-day baseline period, patients were excluded for prior GC or AOM (bisphosphonate, denosumab, teriparatide) use, fracture, or cancer diagnosis. Initiators of an AOM in the 14 days pre- or 90 days post-GC fill were characterized as AOM users; those without, AOM non-users. Follow-up began 91 days after GC fill with patients followed until fracture, loss of continuous enrollment, initiation of AOM by AOM non-users, or end of study period. A propensity score was estimated for AOM receipt using all measured covariates and converted to a stabilized inverse probability of treatment weights (IPTW). Weighted hazard ratios (HR) and associated 95 % confidence intervals (95 % CI) were estimated using weighted Cox proportional hazard models.
Results
Of the 7885 women eligible for the study, 12.1 % were AOM users. AOM use was associated with lower fracture incidence: weighted HR of 0.52 (95 % CI 0.29, 0.94) at 1 year and weighted HR of 0.68 (95 % CI 0.47, 0.99) at 3 years.
Conclusions
AOM initiation within 90 days of chronic GC use was associated with a fracture reduction of 48 % at 1 year and 32 % at 3 years.</abstract><cop>London</cop><pub>Springer London</pub><pmid>25600474</pmid><doi>10.1007/s00198-014-3022-9</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Osteoporosis international, 2015-05, Vol.26 (5), p.1515-1524 |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Administration, Oral Aged Aged, 80 and over Bone Density Conservation Agents - therapeutic use Drug Administration Schedule Drug therapy Endocrinology Female Follow-Up Studies Fractures Glucocorticoids - administration & dosage Glucocorticoids - adverse effects Humans Medicine Medicine & Public Health Middle Aged Original Article Orthopedics Osteoporosis Osteoporosis, Postmenopausal - chemically induced Osteoporosis, Postmenopausal - complications Osteoporosis, Postmenopausal - drug therapy Osteoporotic Fractures - etiology Osteoporotic Fractures - prevention & control Retrospective Studies Rheumatology Studies Women |
| title | Fracture rate associated with quality metric-based anti-osteoporosis treatment in glucocorticoid-induced osteoporosis |
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