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Evaluation of the Implementation of Guidelines on the Treatment of Osteoporosis in Patients with Rheumatoid Arthritis
Sandrine Malochet-Guinamand1,2, Céline Lambert3,4, Laure Gossec3,4
1From the Rheumatology Department, and Biostatistics Unit (DRCI), University Hospital Clermont-Ferrand, Auvergne; Sorbonne University; Pitié Salpêtrière Hospital, AP-HP, Rheumatology Department; Rheumatology Department, Cochin Hospital, AP-HP, Paris Descartes University; Clinical Epidemiology and Biostatistics, INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France. smalochet@chu-clermontferrand.fr.
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.
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