There is still a care gap in osteoporosis management for patients with rheumatoid arthritis

Abstract

Objectives: To assess compliance rates with the current Canadian osteoporosis guidelines and whether the Fracture Risk Assessment Tool score in patients with rheumatoid arthritis correlated with the likelihood of receiving osteoporosis treatment and having a bone mineral density test.

Methods: Charts of serial outpatients with rheumatoid arthritis were reviewed to collect bone mineral density test data and patients' use of calcium, vitamin D, and osteoporosis treatment. Odds ratios (OR) were calculated to determine if a higher Fracture Risk Assessment Tool score increased the likelihood of osteoporosis treatment or having a bone mineral density test.

Results: Using the Fracture Risk Assessment Tool, the 10-year risk of major osteoporotic fracture was high in 92 (12.5%), moderate in 216 (29.3%), and low in 429 (58.2%) patients. Compared to those at low risk, patients identified as high risk were more likely to receive osteoporosis treatment (OR 16.31, 95% CI 9.45-28.13, P<0.001); calcium (OR 3.89, 95% CI 2.43-6.25, P<0.001); vitamin D (OR 3.46, 95% CI 2.12-5.64, P<0.001); and to have had a bone mineral density test (OR 10.22, 95% CI 5.50-18.96, P<0.001). Among 124 patients currently taking prednisone, half (46.8%) were prescribed a bisphosphonate.

Conclusions: Although compliance with current osteoporosis guidelines remains low among all patients with rheumatoid arthritis, higher risk patients were more likely to have a bone mineral density test and receive treatment for osteoporosis, as indicated by the clear dose response seen along the 10-year fracture risk from low to high-risk groups.

Keywords: Adherence; Chart audit predictors of adherence; FRAX; Osteoporosis; RA; Treatment guidelines.