Fragility fractures and prescriptions of medications for osteoporosis in patients with polymyalgia rheumatica: results from the PMR Cohort Study

Abstract

Objectives Polymyalgia rheumatica (PMR) is a common indication for long-term glucocorticoid treatment leading to an increased risk of osteoporosis and fragility fractures. Guidelines recommend calcium and vitamin D for all patients, as well as anti-resorptive agents for high-risk patients. This study aimed to investigate falls and fragility fracture history and use of medications for osteoporosis in a PMR cohort. Methods 652 people with incident PMR responded to a postal survey. Self-reported data on falls, fragility fracture history and medication were collected at baseline. Follow up data on fragility fractures (hip, wrist, spine) and falls were collected at 12 and 24 months. Logistic regression was used to assess the association between baseline characteristics and fractures. Results Fewer than 50% of respondents received osteoporosis treatments, including supplements. 112 (17.2%) participants reported a fragility fracture at baseline, 72 participants reported a fracture at 12 months, whilst 62 reported a fracture at 24-months. Baseline history of falls was most strongly associated with fracture at 12 (OR 2.35; 95% CI 1.35, 4.12) and 24 months (1.91; 1.05, 3.49) when unadjusted for previous fractures. Conclusions Fracture reporting is common in people with PMR. To improve fracture prevention, falls assessment and interventions need to be considered. History of falls could help inform prescribing decisions around medications for osteoporosis. Future research should consider both pharmacological and non-pharmacological approaches to reducing fracture risk.

Treat-to-target recommendations in giant cell arteritis and polymyalgia rheumatica

“…Observational studies indicate that in GCA and PMR, several principles of T2T such as the selection of treatment according to disease severity/activity, consideration of relevant comorbidities, the maintenance of remission at the lowest possible dose of medication and adequate screening and management of comorbidities are not or insufficiently implemented in current clinical practice. [82][83][84] The present project was independent of, and is thus not officially endorsed by a major rheumatological society, however, this was originally also not the case for the RA or psoriatic arthritis/SpA-T2T activities, which were subsequently embraced by EULAR and other organisations. [85][86][87][88] The T2T-SLE recommendations were also developed by an international group without initial endorsement by major professional organisations.…”

Metabolic bone health considerations in giant cell arteritis and polymyalgia rheumatica

“…56 A UK-based cohort study of 652 people with PMR reported 72 fractures at month 12 and 62 at month 24; concerningly less than 50% of patients were prescribed any form of treatment (including calcium/vitamin D) in this study. 57 An Italian study followed 222 PMR patients over a mean duration of 60 months; 55 developed osteoporosis and 31 had fragility fractures. Glucocorticoid dose and duration were significantly associated with osteoporosis and fracture rates.…”