Glucocorticoid-induced osteoporosis (GIOP) is inadequately diagnosed and treated in patients with rheumatoid arthritis (RA), US researchers report.
“The association between osteoporosis and glucocorticoid therapy was first documented in the 1950s after corticosteroids were initiated as treatment for RA,” say Lindsay Ledwich and colleagues from Western Pennsylvania Hospital in Pittsburgh.
However, “there appears to be a nationwide lack of adherence to basic osteoporosis guidelines and a lack of appreciation for GIOP,” they add.
In the present study, Ledwich and team evaluated physician adherence to the American College of Rheumatology (ACR) 2001 ad hoc committee guidelines for the prevention and treatment of GIOP in patients with RA.
They performed a retrospective chart review of patients with RA who received treatment from a rheumatologist in an urban multispecialty outpatient practice between 2002 and 2007.
The charts, from 136 RA patients with an average age of 62 years, were reviewed for corticosteroid dose, corticosteroid duration, baseline bone density scans, use of calcium and vitamin D, use of hormone replacement therapy (HRT), use of calcitonin, and use of a bisphosphonate.
Ledwich and co-authors report in the Journal of Clinical Rheumatology that 73 of the 136 patients qualified as long-term (more than 6 months) corticosteroid users. Of these, only 37% received baseline bone density scans.
The dual energy X-ray absorptiometry scans showed that 70.4% of corticosteroid users experienced some degree of bone loss. Osteopenia was documented in 55.6% of cases while osteoporosis was observed in 14.8% of cases.
According to the ACR guidelines, 18 of the 73 patients taking high-dose corticosteroids should have received the recommended treatment of bisphosphonates or HRT with calcium plus vitamin D. However, only 38.9% of these patients received full treatment and 33% were not given any treatment at all.
Ledwich et al note: “This review of rheumatologists in an urban multispecialty practice showed percentages that fall in line with national averages.”
They conclude: “There still persists a nationwide lack of adherence to the guidelines for managing GIOP irrespective of specialty or expertise.”