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  • Title: Screening and treatment of glucocorticoid-induced osteoporosis in rheumatoid arthritis patients in an urban multispecialty practice.
    Author: Ledwich LJ, Clarke K.
    Journal: J Clin Rheumatol; 2009 Mar; 15(2):61-4. PubMed ID: 19265346.
    Abstract:
    BACKGROUND: Despite increased awareness of glucocorticoid-induced osteoporosis, physicians are not providing recommended screening and treatment. The number of patients receiving bone density measurements, primary prevention, and secondary treatment remains low. OBJECTIVES: To analyze physician adherence of rheumatologists in an urban multispecialty group to the American College of Rheumatology 2001 ad hoc committee guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis in patients with rheumatoid arthritis (RA). METHODS: The practice evaluated is a multispecialty practice in an urban setting affiliated with a teaching hospital. A retrospective chart review was performed. The names of 428 patients with RA were obtained by billing query. One hundred thirty-six charts met criteria for final analysis. Charts were reviewed for long-term corticosteroid use >or=5 mg/d for >or=6 months, baseline bone density scans, use of calcium and vitamin D, use of hormone replacement therapy, use of calcitonin, and use of a bisphosphonate. RESULTS: 59.7% of patients qualified as long-term corticosteroid users. Only 37% of long-term corticosteroid users received baseline bone density scans. Bone loss was documented in 70.4% of corticosteroid users who received baseline DEXA scans. Only 38.9% of long-term corticosteroid users received the recommended treatment of bisphosphonates or HRT with calcium plus vitamin D according to ACR guidelines. CONCLUSIONS: Less then 40% of long-term corticosteroid users with RA received recommended DEXA scanning and treatment in a multispecialty rheumatology urban practice.
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