Background Adherence to osteoporosis (OP) treatment and prevention is not optimal in many patients. Those with rheumatoid arthritis (RA) have a higher risk of OP due to steroid use and systemic inflammation. Ideally patients with RA should be screened for OP.
Objectives To assess whether the Fracture Risk Assessment Tool (FRAX) score in patients with RA correlates with likelihood of osteoporosis (OP) prescription including drug treatment, calcium and vitamin D.
Methods Charts of serial RA outpatients (age>40 with a calculable BMI) were reviewed to determine the 10-year risk of major osteoporotic fracture with the FRAX. Data were extracted on whether a bone mineral density test (BMD) had been performed, use of calcium, vitamin D, and OP treatment. Odds ratios (OR) were calculated to determine if FRAX score increased the likelihood of OP prescribing.
Results Of the 737 patients included; mean age was 62 (SD 11) years, 78% females, with a mean BMI of 28.2 (SD 6), 19% were smokers, 37% were ever received prednisone, 10% had a family history of OP, 2.8% had an OP fracture; 56% had a BMD performed but only half of those were recorded on the chart. Patients did not have a FRAX score calculated in their records. 235 had taken ≥5mg of daily prednisone for ≥3 months. Of the 137 currently taking prednisone, 44.5% were prescribed a bisphosphonate. The 10-year fracture risk was low in the majority of patients (58%) medium risk occurred in 29% and 12.5% were in the high risk group. Calcium was used in 1/3 of low risk, half of medium risk and 2/3 in high risk groups and vitamin D was taken in 41% of low, 68% of medium and 70% of high risk patients. Steroid (ever use) was reported in 24% of low, 50% in medium and 67% in high risk patients. Bisphosphonates were used in 8% of low risk, 1/3 of medium risk and 58% of high risk patients. Compared to those in the lowest risk group, patients identified as high risk were highly significantly more likely to receive OP treatment, calcium and vitamin D and have a BMD performed. In the lowest risk group, those taking ≥5mg prednisone daily for ≥3 months were more likely to be prescribed a bisphosphonate (OR 2.0, p<0.0486). Table: OR compared to low risk group.
Conclusions Patients at higher risk of osteoporotic fractures are more likely to have a BMD and receive pharmacological treatment. Many patients were not taking calcium supplements although their dietary calcium may have been adequate as this could not be calculated from the chart review. However, there is a gap in vitamin D supplementation, and 42% of high risk patients were not currently taking bisphosphonates. There could have been a prescription that was not filled or patient refusal of treatment in addition to lack of suggested treatment. A clear dose response of BMD investigations and treatment is seen along the 10-year fracture risk from low to medium to high risk groups.
Disclosure of Interest None Declared
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