Prescription for antiresorptive therapy in Mexican patients with rheumatoid arthritis: is it time to reevaluate the strategies for osteoporosis prevention?

Abstract

Glucocorticoids are frequently used in rheumatoid arthritis (RA) in order to alleviate symptoms of joint inflammation, retard erosions and to treat extra-articular manifestations, although these drugs may increase the risk of bone mineral loss and osteoporotic fractures. To date, in Mexico there are no studies that identify the frequency of patients with RA with corticosteroids, receiving therapy for osteoporosis. Therefore, we evaluated the prevalence and factors related to the prescription of antiresorptives in 520 Mexican patients with RA. We used a multivariate model to identify variables associated with antiresorptives prescription. We identified that although 79% of patients were under treatment with glucocorticoids, only 13% received antiresorptive agents as preventive therapy for osteoporosis. The multivariate analysis identified that higher proportions of antiresorptive drugs prescriptions were associated with female patients (OR 11.40, 95% CI: 1.5-84.3, P = 0.02), an age of 40 years or more (OR 3.22, 95% CI: 1.3-8.3, P = 0.02) and to consume a lower number of cointerventions with other drugs (OR 1.09, 95% CI: 1.0-1.2, P = 0.03). Corticosteroid treatment was not associated with the prescription of antiresorptives (P = 0.31). In conclusion, a low proportion of Mexicans with RA receive antiresorptive therapy independently regardless of whether they consume or not chronically corticosteroids. Additional strategies should be evaluated to encourage the prevention and early treatment for osteoporosis in patients with RA.

Trends and Determinants of Osteoporosis Treatment and Screening in Patients With Rheumatoid Arthritis Compared to Osteoarthritis

“…Several factors including older age, female gender and postmenopausal state, prior OP diagnosis or fragility fracture, and GC-use irrespective of the duration and dose were identified as strong predictors of OP care in RA patients in this study as shown previously (29, 31, 32). The factors indicating accessibility to and utilization of health care like higher education level, having insurance, urban residency, and vaccination for influenza were also associated with better OP care.…”

Lacunes dans la prise en charge de l’ostéoporose chez les patients atteints de polyarthrite rhumatoïde

“…Ce fait représente un atout majeur de l'étude. Cependant, comme seulement trois rhumatologues ont fait partie de cette étude, la généralisation à d'autres pratiques est incertaine [6,7,19]. Dans une étude précédente dans laquelle une stratification du risque des patients avait été entreprise sur la base de scores FRAX ® , aucune corrélation entre les regroupements selon l'index FRAX ® et la probabilité de recevoir des traitements appropriés de l'ostéoporose n'avait pu être démontrée.…”