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Warriner AH, Outman RC, Allison JJ, Curtis JR, Markward NJ, Redden DT, Safford MM, Stanek EJ, Steinkellner AR, Saag KG. An Internet-based Controlled Trial Aimed to Improve Osteoporosis Prevention among Chronic Glucocorticoid Users. J Rheumatol 2015; 42:1478-83. [PMID: 26136484 DOI: 10.3899/jrheum.141238] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2015] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To address the low prevention and treatment rates for those at risk of glucocorticoid-induced osteoporosis (GIOP), we evaluated the influence of a direct-to-patient, Internet-based educational video intervention using "storytelling" on rates of antiosteoporosis medication use among chronic glucocorticoid users who were members of an online pharmacy refill service. METHODS We identified members who refilled ≥ 5 mg/day of prednisone (or equivalent) for 90 contiguous days and had no GIOP therapy for ≥ 12 months. Using patient stories, we developed an online video addressing risk factors and treatment options, and delivered it to members refilling a glucocorticoid prescription. The intervention consisted of two 45-day "Video ON" periods, during which the video automatically appeared at the time of refill, and two 45-day "Video OFF" periods, during which there was no video. Members could also "self-initiate" watching the video by going to the video link. We used an interrupted time series design to evaluate the effectiveness of this intervention on GIOP prescription therapies over 6 months. RESULTS Among 3017 members (64.8%) exposed to the intervention, 59% had measurable video viewing time, of which 3% "self-initiated" the video. The GIOP prescription rate in the "Video ON" group was 2.9% versus 2.7% for the "Video OFF" group. There was a nonsignificant trend toward greater GIOP prescription in members who self-initiated the video versus automated viewing (5.7% vs 2.9%, p = 0.1). CONCLUSION Among adults at high risk of GIOP, prescription rates were not significantly affected by an online educational video presented at the time of glucocorticoid refill. ClinicalTrials.gov Identifier: NCT01378689.
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Affiliation(s)
- Amy H Warriner
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Ryan C Outman
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Jeroan J Allison
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Jeffrey R Curtis
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Nathan J Markward
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - David T Redden
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Monika M Safford
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Eric J Stanek
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Amy R Steinkellner
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Kenneth G Saag
- From the Division of Endocrinology, Diabetes and Metabolism, and Division of Clinical Immunology and Rheumatology, and Department of Biostatistics, and Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Express Scripts, St. Louis, Missouri; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Real Endpoints LLC, Westport, Connecticut, USA.A.H. Warriner, MD, Division of Endocrinology, Diabetes and Metabolism; R.C. Outman, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; J.J. Allison, MD, MS, Department of Quantitative Health Sciences, University of Massachusetts Medical School; J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; N.J. Markward, PhD, Express Scripts; D.T. Redden, PhD, Department of Biostatistics; M.M. Safford, MD, Division of Preventive Medicine, University of Alabama at Birmingham; E.J. Stanek, PharmD, Novartis Pharmaceuticals Corporation; A.R. Steinkellner, PharmD, Express Scripts* and Real Endpoints LLC; K.G. Saag, MD, MSc, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham.
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Grahnemo L, Jochems C, Andersson A, Engdahl C, Ohlsson C, Islander U, Carlsten H. Possible role of lymphocytes in glucocorticoid-induced increase in trabecular bone mineral density. J Endocrinol 2015; 224:97-108. [PMID: 25359897 PMCID: PMC4254076 DOI: 10.1530/joe-14-0508] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Treatment with anti-inflammatory glucocorticoids is associated with osteoporosis. Many of the treated patients are postmenopausal women, who even without treatment have an increased risk of osteoporosis. Lymphocytes have been shown to play a role in postmenopausal and arthritis-induced osteoporosis, and they are targeted by glucocorticoids. The aim of this study was to investigate the mechanisms behind effects of glucocorticoids on bone during health and menopause, focusing on lymphocytes. Female C57BL/6 or SCID mice were therefore sham-operated or ovariectomized and 2 weeks later treatment with dexamethasone (dex), the nonsteroidal anti-inflammatory drug carprofen, or vehicle was started and continued for 2.5 weeks. At the termination of experiments, femurs were phenotyped using peripheral quantitative computed tomography and high-resolution micro-computed tomography, and markers of bone turnover were analyzed in serum. T and B lymphocyte populations in bone marrow and spleen were analyzed by flow cytometry. Dex-treated C57BL/6 mice had increased trabecular bone mineral density, but lower cortical content and thickness compared with vehicle-treated mice. The dex-treated mice also had lower levels of bone turnover markers and markedly decreased numbers of spleen T and B lymphocytes. In contrast, these effects could not be repeated when mice were treated with the nonsteroidal anti-inflammatory drug carprofen. In addition, dex did not increase trabecular bone in ovariectomized SCID mice lacking functional T and B lymphocytes. In contrast to most literature, the results from this study indicate that treatment with dex increased trabecular bone density, which may indicate that this effect is associated with corticosteroid-induced alterations of the lymphocyte populations.
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Affiliation(s)
- Louise Grahnemo
- Departments of Rheumatology and Inflammation ResearchInternal Medicine and Clinical NutritionCentre for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 480, Gothenburg 405 30, SwedenLaboratory of Tumor Immunology and BiologyCenter for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Caroline Jochems
- Departments of Rheumatology and Inflammation ResearchInternal Medicine and Clinical NutritionCentre for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 480, Gothenburg 405 30, SwedenLaboratory of Tumor Immunology and BiologyCenter for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA Departments of Rheumatology and Inflammation ResearchInternal Medicine and Clinical NutritionCentre for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 480, Gothenburg 405 30, SwedenLaboratory of Tumor Immunology and BiologyCenter for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Annica Andersson
- Departments of Rheumatology and Inflammation ResearchInternal Medicine and Clinical NutritionCentre for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 480, Gothenburg 405 30, SwedenLaboratory of Tumor Immunology and BiologyCenter for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Cecilia Engdahl
- Departments of Rheumatology and Inflammation ResearchInternal Medicine and Clinical NutritionCentre for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 480, Gothenburg 405 30, SwedenLaboratory of Tumor Immunology and BiologyCenter for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA Departments of Rheumatology and Inflammation ResearchInternal Medicine and Clinical NutritionCentre for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 480, Gothenburg 405 30, SwedenLaboratory of Tumor Immunology and BiologyCenter for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Claes Ohlsson
- Departments of Rheumatology and Inflammation ResearchInternal Medicine and Clinical NutritionCentre for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 480, Gothenburg 405 30, SwedenLaboratory of Tumor Immunology and BiologyCenter for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ulrika Islander
- Departments of Rheumatology and Inflammation ResearchInternal Medicine and Clinical NutritionCentre for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 480, Gothenburg 405 30, SwedenLaboratory of Tumor Immunology and BiologyCenter for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Hans Carlsten
- Departments of Rheumatology and Inflammation ResearchInternal Medicine and Clinical NutritionCentre for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 480, Gothenburg 405 30, SwedenLaboratory of Tumor Immunology and BiologyCenter for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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