Screening and treatment of glucocorticoid-induced osteoporosis in rheumatoid arthritis patients in an urban multispecialty practice

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 ≥5 mg/d for ≥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.