Background/Purpose:

High doses of glucocorticoids (GC) are often used in the treatment of Systemic Lupus Erythematous (SLE), however, studies suggest that SLE patients do not receive adequate screening for glucocorticoid induced osteoporosis (GIOP).

The purpose of our study was to evaluate providers’ decisions to order DEXA screening in SLE patients who receive high doses of glucocorticoids for 3 months or longer, in a pragmatic clinical setting

Methods:

We conducted a retrospective cohort study using a large healthcare system clinical database from the years 2011 to 2016. SLE cases with long-term prednisone use (≥ 3 months) at doses of at least 7.51 mg daily were identified via database search and manually reviewed by two clinicians for accuracy. Osteoporosis risk factors were assessed retrospectively via chart review. Fracture Risk Assessment (FRAX®) score was estimated for patients older than 40 years based on chart review. GIOP screening practices were compared with the 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis as the gold standard. A classification tree was used to identify the key patient-related factors that discriminate screening.

Results:

203 SLE patients met inclusion criteria, with 240 total episodes of high dose glucocorticoid usage for ≥ 3 months. 130 patients were 40 years of age or older. Of the patients younger than 40 years, 69 (95%) were female, their median daily dose of prednisone was 15 [10-20.9] mg/day, and the median duration of prednisone usage was 219 [150-409] days. Among those 40 years and older, 105 (81%) were female, their median daily dose of prednisone was 12.5 [10-18.9] mg/day, and the median duration of prednisone usage was 252 [165-518] days. In the younger age group, 27% of patients had DEXA scans ordered vs 8% deemed appropriate per ACR guidelines. Of patients 40 years and older, 63% underwent DEXA scans, versus 100% recommended by ACR guidelines. In a classification tree analysis, DEXA screening was most likely to be ordered for women, those with an estimated FRAX score greater than 9.95, prednisone use duration of 17 months or longer, and a medication count greater than 10.

Conclusion:

Among SLE patients on high dose GC therapy, those younger than 40 had more DEXA scans than deemed appropriate per ACR guidelines, while older patients had fewer. Female sex, higher estimated fracture risk, longer prednisone use, and a higher medication count were key patient-related factors associated with providers’ decisions to order DEXA.

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/to-screen-or-not-to-screendexa-ordering-patterns-in-sle-patients-who-take-systemic-glucocorticoids/