The prevention of glucocorticoid-induced osteoporosis and postmenopausal osteoporosis is inadequate among patients with rheumatoid arthritis (RA), according to results published in The Journal of Rheumatology. Data show that the management of osteoporosis needs improvement in this patient population.
The study assessed the adequacy of the 2003 and 2014 French guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis and the 2012 French guidelines for treating postmenopausal osteoporosis in patients with RA.
The study included 776 participants with RA. The researchers collected data from participants to apply the recommendations, including age, gender, prednisone intake, low energy fracture, immediate family history of hip fractures, and bone densitometry. They also collected data on anti-osteoporotic drugs and other factors that may affect the application of recommendations.
The researchers found that only a fraction of participants who should have received anti-osteoporosis treatment were actually treated: 22.6% according to the 2014 guidelines, 27.3% according to the 2003 guidelines, and 23.6% of postmenopausal women according to the 2012 postmenopausal osteoporosis guidelines.
By applying the 2014 glucocorticoid-induced osteoporosis guidelines, the researchers found that more participants should have received treatment compared with the 2003 guidelines (77% vs. 53%; P <.001).
After performing multivariate analysis, spinal T-score of −2 SD or less was associated with being treated according to the 2014 guidelines. Not performing physical activity for more than 30 minutes per day was associated with being treated according to the 2003 guidelines. Older age, lower body mass index, and a T-score of −2.5 in at least 1 site was associated with being treated according to the postmenopausal osteoporosis guidelines.
“Setting up nurse-led comorbidity consultations may be a solution, even if it appears necessary to assess their long-term utility,” the researchers wrote.
Malochet-Guinamand S, Lambert C, Gossec L, et al. Evaluation of the implementation of guidelines on the treatment of osteoporosis in patients with rheumatoid arthritis [published online March 15, 2019]. J Rheumatol. doi:10.3899/jrheum.180889