Background/Purpose: Despite more aggressive treatment strategies and new biologic DMARDs, the prevalence of osteoporosis (OP) leading to fracture in RA remains high. It is unknown whether these treatment changes and release of the 2010 ACR glucocorticoid (GC) induced OP (GIOP) guideline changed physicians’ OP management practices. To evaluate this, we assessed the frequency, trends, and predictors of OP management care in patients with RA compared with OA in the US.

Methods: Patients studied had RA or OA with ≥1 year participation from 2003 through 2014 in the National Data Bank for Rheumatic Diseases. OP management care was defined as either having a bone mineral density (BMD) test or treatment with any anti-OP medications (excluding calcium or vitamin D) in the prior 6 months. Calendar years were evaluated to detect trends for outcome, with 2003 as reference period. Andersen-Gill formulation of Cox proportional hazards models were used to determine adjusted trends of and factors associated with OP management care.

Results: During a median (IQR) followup of 5.5 (2.3-9.0) years in 11,669 RA and 2,829 OA patients, the frequencies of BMD testing were 57% vs. 54% and treatment with any anti-OP medication 44% vs. 42%. Only ~50% of RA and OA patients with prior fragility fractures or long-term GC exposure were on anti-OP treatment. In multivariable analysis, RA patients were 12% more likely to have OP management care compared to OA patients. Factors significantly associated with having OP management care in RA patients were older age, postmenopausal status, prior fragility fracture or diagnosis of OP, GC exposure ≥3 months, treatment with any biologic, and rheumatology care (Table). Cox models showed stable OP management trends between 2003 and 2009, with a significant downward trend after 2009 without any improvement in GC-exposed patients after the release of the 2010 ACR GIOP guideline (Figure). The same downward trend was also observed in long-term GC exposed by bisphosphonate-nonexposed RA patients.

Conclusion: The application of OP management care is slightly higher in RA patients compared to OA, but the frequency of such care in patients at high risk for fracture remains suboptimal. Despite the availability of advanced treatments, the care for OP has not been improving, which may be due to both patient (unwillingness to take more drugs, cost) and physician barriers (lack of time, and focusing more on disease activity and other comorbid conditions). To reduce the morbidity and mortality burden of OP fractures, clarification of the reasons for suboptimal management and effective interventions are needed.