Evaluation of the Implementation of Guidelines on the Treatment of Osteoporosis in Patients with Rheumatoid Arthritis.

Abstract

OBJECTIVE:

To assess whether the 2003 and 2014 French guidelines on the prevention and treatment of glucocorticoid-induced osteoporosis (GIOP) and the 2012 update of the French guidelines for the treatment of postmenopausal osteoporosis (PMOP) were applied in patients with rheumatoid arthritis (RA).

METHODS:

We conducted a cross-sectional study of 776 patients with RA (19 centers). We collected the data required for the application of the various recommendations (age, sex, prednisone intake, low-energy fracture, history in the immediate family of hip fractures, and bone densitometry), anti-osteoporotic drugs, and the various factors that may be associated with the application of the recommendations.

RESULTS:

Of the patients who should have received antiosteoporosis treatment, there were 22.6% actually treated (according to the 2014 guidelines), 27.3% actually treated according to the 2003 guidelines, and of postmenopausal women, 23.6% (according to the 2012 PMOP guidelines). Applying the 2014 GIOP guidelines increased the theoretical number of patients requiring treatment relative to the 2003 GIOP guidelines (77% vs 53%; p < 0.001). In multivariate analysis, being treated was associated with a spinal T score ≤ -2 SD according to the 2014 guidelines; with not taking part in physical activity for more than 30 min a day according to the 2003 guidelines; and with older age, lower body mass index, and a T score ≤ -2.5 SD in at least 1 site according to the PMOP guidelines.

CONCLUSION:

Patients with RA had inadequate prevention of GIOP and PMOP. The management of osteoporosis needs to be improved in this population.

• Authors: Sandrine Malochet-Guinamand, Céline Lambert, Laure Gossec, Martin Soubrier, Maxime Dougados
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 47 Issue 1 Pg. 6-14 (01 2020) ISSN: 0315-162X [Print] Canada
• PMID: 30877214 (Publication Type: Clinical Trial, Journal Article, Multicenter Study)

Chemical References

• Bone Density Conservation Agents
• Diphosphonates
• Glucocorticoids
• Prednisone

Topics

• Aged
• Arthritis, Rheumatoid (complications, drug therapy)
• Bone Density
• Bone Density Conservation Agents (therapeutic use)
• Cross-Sectional Studies
• Diphosphonates (therapeutic use)
• Female
• Femoral Neck Fractures (drug therapy)
• Glucocorticoids (adverse effects, therapeutic use)
• Humans
• Male
• Middle Aged
• Osteoporosis, Postmenopausal (chemically induced, complications, drug therapy)
• Osteoporotic Fractures (drug therapy)
• Practice Guidelines as Topic
• Prednisone (adverse effects, therapeutic use)
• Risk Factors
• Spinal Fractures (drug therapy)
• Treatment Outcome