Background:
Osteoporosis is a major risk factor for fractures and is more prevalent in patients with inflammatory rheumatic disease. Our aim was to determine the prevalence of osteoporosis and minimal trauma fractures in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and giant cell arteritis (GCA) and the frequency of osteoporosis assessment and management and its determinants.
Methods:
A retrospective chart review was performed on patients ≥50 years of age with a clinician made diagnosis of RA, PsA or GCA who received treatment from a rheumatologist on ≥3 occasions in the outpatient Rheumatology service at Concord Hospital from 2015-2020. Those who had an undifferentiated inflammatory arthritis or inflammatory arthropathy due to other systemic inflammatory diseases were excluded. A customised data collection tool was designed in REDCap (Research Electronic Data Capture) to collect demographic details, lifestyle risk factors, disease duration, history of minimal trauma fractures, DEXA testing and osteoporosis management. Descriptive statistics, Chi-square analyses and bivariate logistic regression with assistance of a statistician was performed.
Results:
A total of 277 patients were included with RA (n=194), PsA (n=60) and GCA (n=23). Patients with RA and GCA were more likely to be older and female. 31.8% of patients had osteoporosis with a history of minimal trauma fractures in 19.1%, with the majority being vertebral or hip. DEXA scanning was performed in only 48% of patients, with determinants for scanning being female, increasing age, a diagnosis of RA or GCA or history of fractures. 83% of osteoporotic patients were on specific pharmacotherapy.
Conclusion:
The detection of osteoporosis in patients with RA, PsA and GCA remains suboptimal and qualitative studies are required to understand barriers to enable tailored interventions to improve care. Retrospective data collection and clinical care is made challenging by the absence of a centralised medical records system which incorporates external investigations.