Corticosteroid Use, Bone Density Screening, and the Influence of Insurance in Patients with Inflammatory Bowel Disease: A Retrospective Analysis

Background: Corticosteroid use among inflammatory bowel disease (IBD) patients is common as they are highly effective in the management of flares. However, both corticosteroid use and IBD have been linked to bone mineral density deficiencies. As a result, guidelines recommend dual-energy X-ray absorptiometry (DEXA) screening in these patients. The main objectives of this study were threefold: to quantify the amount of corticosteroids prescribed per patient, assess whether patients were appropriately referred for DEXA scans according to CMS guidelines, and to evaluate the rate of completion for the ordered DEXA scans. Additionally, we aimed to evaluate whether insurance status impacted the cumulative amounts of corticosteroids prescribed and access to DEXA scans. Methods: 16,387 adult patients who were seen at two tertiary healthcare systems in the southeastern United States with a diagnosis of IBD were included. Patient characteristics and DEXA scan referral rates were obtained. Patients prescribed ≥600 prednisone equivalents were deemed to qualify for DEXA scan screening. Results: Underinsured patients (UP) were prescribed significantly more prednisone and less budesonide than insured patients (IP). There was no significant difference in scan completion rate: 66.7% for UP and 75.6% for IP. Overall, the completion rates for DEXA scans among patients prescribed ≥600 equivalents were 19.6% for UP and 20.3% for IP, with an overall rate of 20.3%. Conclusion: DEXA scan screening for bone mineralization deficits is underperformed for IBD patients on chronic steroid therapy. Insurance had no impact on the ordering or completion rate of DEXA scans in our study. Trial Registration: Retrospectively registered