Background Osteoporotic fragility fractures decrease physical performance and disability-free life expectancy. Patients with rheumatic disease develop osteoporosis due to local cytokine production, low levels of physical activity, and glucocorticoid therapy. Rheumatologists need to proactively manage osteoporosis in patients with rheumatic disease to extend their healthy and disability-free life years. While studies have reported that approximately 50% of postmenopausal patients with osteoporosis discontinue anti-osteoporotic therapy within 1 year, there is a paucity of data on treatment continuation and discontinuation in patients with rheumatic disease.
We conducted a retrospective analysis of the status of oral anti-osteoporotic therapy in patients with rheumatic disease using the prescription database at a single rheumatology specialty center from June 2007 to May 2010, a period before teriparatide, a recombinant form of parathyroid hormone, and denosumab, a monoclonal antibody to receptor activator of nuclear factor kappa B ligand, were approved for clinical use.
Objectives To estimate persistence with oral anti-osteoporotic therapy in patients with rheumatic disease and identify factors influencing the persistence and reasons for discontinuation.
Methods Based on prescription database, we identified patients who started treatment with alendronate, risedronate, or selective estrogen receptor modulators during the study period. Patients who continued treatment after June 1, 2010, were “censored”. Patients who did not receive a prescription for 190 or more days during the study period were classified as “discontinued”. Persistence were estimated using Kaplan-Meier survival analysis. Multivariate Cox proportional hazard analysis was carried out to identify factors influencing the persistence. Reasons for discontinuation were abstracted from medical charts.
Results Analysis of prescription database identified 557 patients (477 females and 80 males). Of these, 378 had rheumatoid arthritis, and 112 had systemic lupus erythematosus, dermatomyositis, systemic sclerosis, vasculitis syndrome, or other connective tissue diseases. Mean age at the start of anti-osteoporotic therapy was 62.1 years, and 481 patients (86.4%) received a mean prednisolone dose of 8.4 mg/day. Persistence with anti-osteoporotic therapy was 71.9%, 61.1%, 50.1% after 1, 2, and 3 years, respectively. Factors associated with persistence were the diagnosis of connective tissue disease and use of glucocorticoids. Among patients who discontinued therapy, the most frequent reason for discontinuation of anti-osteoporotic therapy was onset of adverse events (32.4%).
Conclusions Patients with rheumatic disease receiving anti-osteoporotic therapy had a higher persistence than postmenopausal patients with osteoporosis. These results suggest that rheumatologists should take a proactive stance on managing osteoporosis in patients with rheumatic disease.
Disclosure of Interest None declared