Background/Purpose: The majority of bone loss happens within 6 months of glucocorticoid treatment. Per the 2022 American College of Rheumatology (ACR) Glucocorticoid-Induced Osteoporosis Guidelines it is strongly recommended to assess for fracture risk in all patients ≥18 years old initiating or continuing glucocorticoid therapy ≥2.5mg/day for >3 months with a Bone Mineral Density (BMD). Moreover, Rheumatoid Arthritis is an independent risk factor for decreased bone mineral density and warrants early assessment for fracture risks.

Methods: Single center, retrospective chart review on a 10 years timeframe (11/01/2013– 11/01/2023). Chi-square analysis was performed with Graphpad Prism software.

Results: A total of 11,228 Rheumatoid Arthritis patients were analyzed, out of which 5838 were on prednisone or equivalent dose ≥2.5mg daily >3 months. Out of those, only 764 had a DEXA Scan done (15.06%). On the other hand, out of the 5390 patients that were not on corticosteroids, 323 had a DEXA Scan (Table 1, 5.99%; p< 0.00001). Notably, RA patients with bone fractures (femur or forearm) that were on glucocorticoids were not screened adequately, as compared to patients not having fragility fractures (Table 1, p= 0.004924 and p=0.000013 respectively). Interestingly, patients without Rheumatoid Arthritis that had femoral, vertebral or forearm fractures were screened adequately regardless of previous glucocorticoids use (Table 2, p< 0.00001 in all three scenarios). 

Conclusion: There’s a suboptimal osteoporosis screening in glucocorticoid-treated Rheumatoid Arthritis patients. Osteoporosis screening is adequate in general population when having fragility fractures.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/glucocorticoid-therapy-associated-bone-fractures-are-associated-with-osteoporosis-underscreening-in-patients-with-rheumatoid-arthritis/