Osteoporosis management in patients with rheumatoid arthritis: Evidence for improvement

Abstract

Objective. Osteoporosis in patients with rheumatoid arthritis (RA) is increasingly recognized as a major comorbidity. We examined past management patterns for glucocorticoid-induced osteoporosis and attempted to improve care through an educational intervention. The goal was to examine the frequency of osteoporosis management in patients with RA treated at a large academic rheumatology practice. Methods. We performed a structured chart review on randomly selected patients seen during 2004 for RA. Osteoporosis management was defined as a bone mineral density test or receipt of a medication for osteoporosis in the prior 24 months. The frequency of osteoporosis management among our study group was assessed. We also examined how glucocorticoid dosage affected osteoporosis management in adjusted models. Results. We reviewed the records for 193 patients, 99 had not used glucocorticoids in the prior 24 months, and 94 had used them. Of the total study population, 48% had received a bone mineral density test or medication for osteoporosis. Some form of osteoporosis management was present for 64% of patients taking >5 mg prednisone for >3 months compared with 38% for patients taking none (P ‫؍‬ 0.002). Predictors of osteoporosis management included older age, female sex, glucocorticoid dosage, and prior osteoporosis diagnosis or fracture. Conclusion. The frequency of osteoporosis management appears to have increased compared with a prior chart review.

Prevention of glucocorticoid‐induced bone loss in mice by inhibition of RANKL

“…In this study, we evaluated the effects of RANKL inhibition on BMD, bone histomorphometry, and bone strength in hRANKL-knockin mice, using an established murine model of glucocorticoid-induced osteoporosis (4). Consistent with the data obtained by Weinstein et al (4), we found that systemic glucocorticoid excess induced by subcutaneous slow-release pellets mimics most of the clinical features of glucocorticoid-induced osteoporosis in humans (1,27). Prednisolone treatment caused loss of vertebral cancellous bone area in wild-type mice and loss of endocortical bone in the spine and in the femur of hRANKL-knockin mice.…”

“…Glucocorticoids are used in the clinical management of a broad spectrum of immune-mediated and inflammatory diseases, including rheumatoid arthritis (RA) (1). Profound, rapid-onset bone loss and fragility fractures are frequent and severe complications of systemic glucocorticoid therapy.…”

Glucocorticoid-Induced osteoporosis: clinical and therapeutic aspects

“…This observation is particularly evident in males taking glucocorticoids, in accordance with the general inadequate awareness of male osteoporosis (58,59). The awareness of GIO is higher in elderly female patients (60). Less than half of glucocorticoid-treated male patients are assessed with a bone mineral density (BMD), and less than one-third receive treatment (57).…”

“…Physicians apparently do not appreciate the potential relevance of glucocorticoid use to bone loss. One hopes that well-conducted long-term "educational" programs will improve this situation (60).…”

Bisphosphonates in Patients with Glucocorticoids: Time for Implementation

“…In the US, only 48% of GC-treated patients received bone mineral density (BMD) testing or medication for osteoporosis 7 , and comparable data were found in The Netherlands 8 . It has been reported that lack of knowledge by physicians, having limited time during the outpatient-clinic visit, and patient-related factors of nonadherence are among the important barriers in the management of GIOP 9 .…”