Background/Purpose: Osteoporosis is a well-known extra-articular complication in rheumatoid arthritis (RA) patients  It is more common in patients with RA than in the general population, due to active systemic inflammation, the use of corticosteroids, and lack of mobility. The prevalence of concurrent osteoporosis in RA patients is 50% The International Society for Clinical Densitometry (ISCD) and National Osteoporosis Foundation (NOF) has recommended dual-energy x-ray absorptiometry (DEXA) testing for all adult RA patients due to their high-risk status. However, a significant percentage of RA patients do not undergo DEXA scan despite these recommendations. Our aim was to assess osteoporosis screening rates in African American patients with RA.

Methods: Patients with a diagnosis of RA who visited a primary care clinic of Grady Memorial Hospital between July 1, 2017, and June 30th, 2018 were included (n=132) Data were extracted from the electronic medical record (EMR) system. We obtained data regarding the diagnosis of low bone marrow density in terms of osteoporosis and osteopenia through dual-energy x-ray absorptiometry (DEXA Scan) of the hip and lumbar spine. Medication use included steroids, methotrexate, leflunomide, azathioprine, hydroxychloroquine, adalimumab, and any other disease-modifying antirheumatic drugs.   STATA software was used and two-sided P-value < 0.05 was considered statistically significant.

Results: Out of 132 patients (74% females, 98% African American, median age 55), only 60 patients had a DEXA scan on file. Of these 60 patients, 50% had low bone marrow density. Osteoporosis and osteopenia prevalence were 40% (24/60) and 10% (n= 6/60) respectively. 43% (N =57 people) were on steroids at the time of data collection and had indications for osteoporosis screening based on the American College of Rheumatology’s guidelines but only 30% had a DEXA scan on file. Out of 24 patients, who had osteoporosis, 50% (n=12/24) were on bisphosphonates and 33% of them had repeat DEXA scan in 2 years. The patients who were on steroids were more likely to have screening done as compared to patients who were not on steroids. (OR=2.29 CI 1.1-4., p=0.0234). The patients’ age 50-60 were less likely to have DEXA scan on file compared to patients age > 60 (OR=0.29 CI 0.1-0.7 P = 0.01). There was no statistically significant difference in DEXA screening rates between patients with multiple comorbidities versus patients with RA only or patients with low vitamin D versus normal vitamin D.

Conclusion: Our study provides information on osteoporosis screening in predominantly African American RA patients. About half of RA patients for whom treatment was indicated never received an Osteoporosis medication. Our study shows the improper implementation of guidelines in our high-risk patient population which is consistent with previous studies. The results of this audit will make us more vigilant to identify those patients who need DEXA scanning to ensure that treatment is efficacious. Future goals are to set up a resident-driven intervention to not only educate providers about the increased risk of osteoporosis in RA patients but to also increase guideline compliance rates.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/osteoporosis-screening-in-african-american-patients-of-rheumatoid-arthritis-patients-are-we-doing-enough/