Background/Purpose: The National Osteoporosis Foundation (NOF) 2008 guidelines recommend treatment for postmenopausal women (PMW) and men ≥ 50 if the T-score is ≤-2.5 at the hip or spine and in patients with osteopenia (T-score -1.0 to -2.5) if the WHO FRAX^® 10-yr fracture risk is ≥3% for hip or ≥20% for major osteoporotic fractures. We evaluated treatment initiation in patients after DXA and compared treatment by rheumatologists to non-rheumatologists.

Methods: The Cleveland Clinic DXA registry was linked with the patient’s electronic medical record using Explorys Inc. PMW and men ≥50 in the registry between 7/2009 and 12/2012, who were anti-osteoporosis medication (AOP) naïve, and had at least one office visit in the years pre and post-DXA were included. New use of AOPs; bisphosphonates, teriparatide, denosumab, raloxifene, calcitonin, and estrogen started within 90, 180, and 365 days post-DXA were collected through 2/2013. Subjects who did not exceed each post-DXA time period were not included in the analysis. Subjects were stratified into 6 groups based on T-score (osteoporosis or osteopenia); FRAX^® 10-yr risk of major osteoporotic fracture or hip fracture, ≥20% and/or ≥3% (high-risk) or <20% and <3% (low-risk); and treatment by a rheumatologist or non-rheumatologist. Results are presented as % difference in treatment starts. Group comparisons were made using chi-square with p≤0.05 demonstrating statistical significance.

Results:  Study subjects had a mean age of 70.9 (SD 10.5) and 80.8% (3456/4280) were female. The difference in treatment starts at 90, 180 and 365 days after initial DXA for rheumatologists and non-rheumatologists are presented in Table 1. The groups were osteoporosis at either spine or hip and FRAX^® high-risk; osteoporosis and FRAX^® low-risk; osteopenia and FRAX® high-risk. Rheumatologists were compared to non-rheumatologists. Treatment would be recommended for all 6 groups based on NOF guidelines. Rheumatologists started significantly more patients on AOP than non-rheumatologists at 180 and 365 days in patients with osteoporosis and FRAX ^® high-risk, and at all-time points in patients with osteopenia and FRAX^® high-risk. The greater number of AOP starts in rheumatologists indicate closer adherence to NOF guidelines for treatment.

Conclusion: Rheumatologists started AOP therapy significantly more often in patients who would be recommended for therapy based on NOF guidelines. However, only 67.2% of rheumatology and 54.9% of non-rheumatology FRAX^® high-risk with osteoporosis patients were started on AOP by 1-yr. In FRAX^® high-risk with osteopenia patients only 40.5% of those treated by a rheumatologist and 27.8% of those not treated by a rheumatologist were started on therapy at 1-yr. These data indicate a care gap in osteoporosis treatment in both physician groups which needs to be addressed to improve quality of care.