Background/Purpose:

Rheumatologic diseases (RDs) have been associated with an increased risk of osteoporosis (OP) and osteoporotic fractures, however, most patients do not receive diagnosis and adequate treatment. The aim of our study was to study the prevalence of OP and osteoporotic fractures in relation to RDs.

Methods:

We used National Inpatient Sample (2000-2014) to identify hospitalizations ≥18 years of age with OP and osteoporotic fractures and excluded fractures due to other etiologies. We studied the yearly trends of OP and osteoporotic fractures as well as compared the trends among hospitalizations with or without RDs in terms of Annual Percentage Change (APC).

Results:

OP was noted to have an increasing trend from 2000 – 2009 (APC=5.81, p<0.05) with a decline thereafter (APC=- 3.88, p <0.05). In contrast, osteoporotic fracture showed an initial downward trend from 2000-2010 (APC=-7.31, p<0.05), followed by a slowly rising trend (APC=2.0, p=NS) (Figure 1). The trends were similar in groups with or without RDs (Figure 2). RDs had higher odds of OP [ORs 2.58 (95 % CI 2.55 – 2.60), p<0.001] and osteoporotic fractures [OR 1.28 (95% CI 1.25 -1.31), p<0.001] (Table 1).

Conclusion:

RDs were associated with increased OP and osteoporotic fractures; the pathogenesis includes disease-related (chronic inflammation) and treatment-related (glucocorticoid induced) factors. Decreasing trend was noted along with a halt in a previously declining fracture rates. The noted decrease in OP might represent a true decline due to better prevention, but may also be due to decreased screening and subsequent detection. Also, if the decreased trend was due to better prevention, one would expect osteoporotic fractures to decrease as well. Potential explanations include inadequate screening per guidelines, suboptimal treatment and decreasing patient compliance, which have also been documented in many prior studies.

In conclusion, primary and secondary prevention measures for OP have been underutilized by both physicians and patients alike, although several possibilities exist. Awareness of this is vital to increase physician prescribing practices and patient compliance.