Adherence With Current Osteoporosis Treatment Guidelines Among Rheumatologists Caring For Patients With Rheumatoid Arthritis Using Items From The Fracture Risk Assessment Tool Score

Jennifer Watt¹, Andrew E. Thompson², Nicole G. H. Le Riche³ and Janet E. Pope⁴, ¹Medicine, University of Western Ontario, London, ON, Canada, ²Rheumatology, St. Josephs Health Ctr, London, ON, Canada, ³Department of Medicine, St. Joseph's Hospital, London, ON, Canada, ⁴Medicine, Divsion of Rheumatology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: guidelines, osteoporosis, Rheumatoid arthritis (RA), risk assessment and steroids

Session Information

Session Title: Osteoporosis and Metabolic Bone Disease: Clinical Aspects and Pathogenesis

Session Type: Abstract Submissions (ACR)

Background/Purpose:

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. Use of calcium, vitamin D, OP treatment, and a patient’s BMD results were recorded. Odds ratios (OR) were calculated to determine if a higher FRAX score increased the likelihood of OP prescribing.

Results:

10-year risk of fracture was high in 92 (12.5%), moderate in 216 (29.3%), and low in 429 (58.2%). No patients had a FRAX score calculated in their records. Compared to those at low risk, patients identified as high risk were more likely to receive OP treatment (OR 16.31, 95% CI 9.45-28.13, p<0.0001); calcium (OR 3.89, 95% CI 2.43-6.25, p<0.0001); vitamin D (OR 3.46, 95% CI 2.12-5.64, p<0.0001); and have a BMD performed (OR 10.22, 95% CI 5.50-18.96, p<0.0001). Among 137 patients currently taking prednisone, 44.5% were prescribed a bisphosphonate. BMD tests were performed in 415 (56.3%), but only 228 were recorded on the specialists’ charts.

Conclusion:

Higher risk patients are more likely to have a BMD and receive treatment, as indicated by the clear dose response seen along the 10-year fracture risk from low to medium to high-risk groups. Although rheumatologists didn’t calculate the FRAX score, they recognize important clinical risk factors included in the FRAX tool.

Disclosure:

J. Watt,
None;

A. E. Thompson,
None;

N. G. H. Le Riche,
None;

J. E. Pope,
None.

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