The following article is a part of conference coverage from the American College of Rheumatology Convergence 2020, being held virtually from November 5 to 9, 2020. The team at Rheumatology Advisor will be reporting on the latest news and research conducted by leading experts in rheumatology. Check back for more from the ACR Convergence 2020.
Adherence to the 2017 American College of Rheumatology (ACR) guidelines for the management of glucocorticoid-induced osteoporosis (GIOP) increases osteoporosis screening and therapy initiation, and can reduce the risk for complications related to osteoporosis, according to study results presented at the ACR Convergence 2020, held virtually from November 5 to 9, 2020.
According to the 2017 ACR guidelines for the management of GIOP, baseline dual-energy x-ray absorptiometry (DEXA) scans at initiation of glucocorticoid therapy is recommended for patients receiving a daily dose of 2.5 mg or more of glucocorticoids for 90 days or more, with repeat scans every 2 to 3 years while on treatment. When assessing the Fracture Risk Assessment Tool (FRAX) score for patients receiving glucocorticoids at a daily dose of greater than 7.5 mg, the guidelines recommend that the score should be increased by 1.15 for major osteoporotic fractures and 1.2 for hip fractures. Treatment for osteoporosis is recommended for patients at moderate to high risk or for those on daily doses of 30 mg or more of glucocorticoids, with a cumulative dose of less than 5 g.
The objective of the current study was to emphasize the importance of the 2017 ACR GIOP guidelines and increase appropriate screening for osteoporosis and initiating therapy.
The retrospective study included patients from 3 outpatient clinics affiliated with the University of South Florida, Florida, between April 2018 and November 2019. The study included an intervention aimed at educating the providers and previsit chart reviews to identify patients at risk based on the guidelines. Retrospective chart review was performed after the intervention between November 2019 and April 2020.
The preintervention group included 385 patients (55.6% women; average age, 63.9 years) receiving glucocorticoid doses of 2.5 mg or more for 90 days or more; the post-intervention group included 230 patients (47.0% women; average age, 64.2 years). Rheumatoid arthritis was the most common disease in both groups. Prednisone was the most frequently prescribed glucocorticoid, which was prescribed at a dose of less than 5 mg to greater than 10 mg in approximately one-third of patients in both groups.
After the intervention, a statistically significant increase in appropriate DEXA scans was reported (from 56.9% to 68.3%, P =.005). While there was an overall increase in screening rates for osteoporosis among each condition after the intervention, it was not statistically significant. Furthermore, no increase in screening rates was reported for patients receiving glucocorticoid at a daily dose of 30 mg or more in the preintervention vs postintervention group (48.3% vs 48.0%). However, the intervention was followed by an increase in rates of appropriate treatment for osteoporosis (from 30.3% to 48.1%; P =.002).
A modification to FRAX that adjusts the fracture risk to glucocorticoid use according to the guidelines upgraded lower FRAX risk scores to higher risk scores, findings that were evident in both the groups.
“Implementation of the 2017 ACR GIOP guidelines increased DEXA screening and [osteoporosis] therapy initiation in the postintervention group by improving the identification of high-risk patients. Abiding by these guidelines will lead to a reduction in further [osteoporosis] complications,” the study authors concluded.
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Sierra MF, Vafa A, Cao S, et al. Improving glucocorticoid-induced osteoporosis screening and management in patients with rheumatic diseases using the 2017 ACR Guidelines. Presented at: ACR Convergence 2020; November 5-9, 2020. Abstract 0113.