This article is more than 5 years old. Information may no longer be current.
Less than half of patients with RA receive recommended osteoporosis care
Click Here to Manage Email Alerts
Less than 50% of patients with rheumatoid arthritis directed to receive guideline-recommended osteoporosis treatment received appropriate care, according to recent findings.
In the study, researchers identified 11,669 patients with RA and 2,829 patients with osteoarthritis who were participants in the National Data Bank for rheumatic diseases, a longitudinal, prospective, observational study. Participants were mainly enrolled by rheumatologists and were followed up semiannually with self-report questionnaires. Those eligible for analysis completed at least two of these semiannual questionnaires between 2003 and 2014. Participants were followed until patient death, loss to follow-up or end of study period.
The study’s primary outcome was osteoporosis treatment or screening (OPTS), which was defined as being tested for bone mineral density or receiving any osteoporosis treatment according to patient self-report. A secondary outcome, called OPTS-American College of Rheumatology, involved the use of alendronate, risedronate, zoledronic acid or teriparatide (Forteo, Eli Lilly) — for prevention of glucocorticoid-induced osteoporosis (GIOP) — in addition to bone mineral density testing.
Ten-year fracture probabilities were calculated using the U.S. version of the FRAX tool. This method considers clinical risk factors to estimate the 10-year likelihood of a major osteoporotic fracture of the hip, clinical spine, forearm or humerus, or hip fracture alone. Risk factors assessed included race, sex, BMI, previous fragility fracture, parental history of hip fracture, current tobacco smoking, any long-term glucocorticoid use, RA, other causes of secondary osteoporosis and alcohol consumption. They used the Andersen-Gill multiple failure Cox proportional hazards model to determine adjusted trends of and factors linked to OPTS.
The researchers found that during a median follow-up of 5.5 years in RA and 5.5 years in OA, OPTS was reported in 67.4% of patients with RA and OPTS-ACR was reported in 61.8% of patients with RA, whereas OPTS was reported in 64.6% of patients with OA and OPTS-ACR was reported in 56.7% of patients with OA.
In an analysis applying the ACR GIOP guidelines, it was determined that 48.4% of patients with RA (53.8% of postmenopausal women and 44.5% of men aged at least 50 years) and 17.6% of patients with OA (19.3% of postmenopausal and 11.4% of men aged at least 50 years) were candidates for receiving osteoporosis treatment. However, in patients with RA and OA, only 55% were treated with any osteoporosis medication and 37% were treated with an ACR-recommended osteoporosis medication. After applying National Osteoporosis Foundation (NOF) guideline recommendations, 49.3% of patients with RA (54.3% of postmenopausal women and 47.6% of men aged at least 50 years) and 51.4% of patients with OA (54.8% of postmenopausal women and 41.2% of men aged at least 50 years) were considered candidates for osteoporosis treatment.
Osteoporosis treatment in this analysis was reported in 54.5% of patients with RA and 49.3% of patients with OA. Compared with patients with OA, those with RA did not have a higher likelihood of undergoing OPTS (HR = 1.04; 95% CI, 0.93-1.15). In fully adjusted models, a consistent trend of OPTS treatment was seen between 2004 and 2008 compared with 2003. After 2008, however, a significant downward trend was observed, with no meaningful improvement after the release of the 2010 ACR GIOP guideline.
The following were found to be predictors of undergoing OPTS or OPTS-ACR: older age, postmenopausal status, having insurance, education level, urban residency, immunization for influenza, prior fragility fracture or osteoporosis diagnosis, any length of glucocorticoid treatment and use of biologic agents.
“Approximately 50% of RA patients were at sufficient risk for fracture to warrant [osteoporosis] treatment either by ACR GIOP or NOF guidelines, but half of these patients were never treated appropriately,” the researchers wrote. “Clarification of patient- and provider-related factors for suboptimal management are needed to develop effective interventions and reduce the burden of osteoporotic fractures.” – by Jennifer Byrne
Disclosures: The authors report no relevant financial disclosures.
Collapse
Click Here to Manage Email Alerts