[Prophylaxis and treatment of osteoporosis in patients with rheumatoid arthritis (ORA study)].

Abstract

OBJECTIVE:

The aim of this study was to examine bone mineral density (BMD), frequency of osteopenia and osteoporosis in a representative sample of patients with rheumatoid arthritis (RA) and to describe chemoprophylaxis and treatment of osteoporosis compared to evidence-based guidelines.

PATIENTS AND METHODS:

In 2005 and 2006, 532 patients with RA (98 men, 434 women) aged 23-87 years were recruited from 9 German rheumatology centers. Clinical examination included a detailed documentation of osteoporosis medication. Dual-energy X-ray absorptiometry (DXA) was used to measure BMD at the lumbar spine and femoral neck. Osteopenia and osteoporosis were defined according to the criteria of the World Health Organization.

RESULTS:

Of the RA patients 29% had normal BMD at the spine and femoral neck, 49% of the patients had osteopenia and 22% met the criteria for osteoporosis at any site. Of the patients 60% were receiving medication for prophylaxis or therapy of osteoporosis, 38% calcium/vitamin D alone, 20% as combinations mostly of calcium/vitamin D + bisphosphonate, 1% received bisphosphonate only and 1% hormone replacement therapy. Although the frequency of osteoporosis showed no significant differences between male and female patients, women with RA used osteoporosis medication more often than men (63% versus 49%, χ²-test, p <0.05). A total of 101 RA patients (83 menopausal women, 6 premenopausal women, 12 men) received corticosteroids in a daily dose of 7.5 mg or less for at least 3 months and had DXA T-scores below -2.0 at any site. In this patient group 41% of the menopausal women, 17% of the premenopausal women and 42% of the male patients were reported to receive medication with calcium/vitamin D + bisphosphonate. Calcium/vitamin D was used by 35% of the menopausal women, none of the premenopausal women and 50% of the male patients and 18% of the menopausal women, 67% of the premenopausal women and 8% of men received no prophylaxis or treatment for osteoporosis.

CONCLUSION:

According to the DVO (German Society for Osteoporosis) guidelines for osteoporosis (2009) menopausal women with corticosteroid therapy < 7.5 mg per day for at least 3 months and DXA T-scores below -2.0 should receive treatment with bisphosphonate and calcium/vitamin D. The data show that there were still deficits concerning prophylaxis and treatment of osteoporosis in RA.

• Authors: I Heberlein, W Demary, H Bloching, J Braun, F Buttgereit, R Dreher, C Kuhn, U Lange, W Pollähne, A Zink, H Zeidler, H Häntzschel, H Raspe
• Journal: Zeitschrift fur Rheumatologie (Z Rheumatol) Vol. 70 Issue 9 Pg. 793-8, 800-2 (Nov 2011) ISSN: 1435-1250 [Electronic] Germany
• Vernacular Title: Medikamentöse Osteoporoseprophylaxe und -Therapie bei Patienten mit Rheumatoider Arthritis (ORA-Studie).
• PMID: 21956827 (Publication Type: English Abstract, Journal Article)

Chemical References

• Bone Density Conservation Agents

Topics

• Adult
• Aged
• Aged, 80 and over
• Arthritis, Rheumatoid (diagnosis, drug therapy, epidemiology)
• Bone Density (drug effects)
• Bone Density Conservation Agents (therapeutic use)
• Bone Diseases, Metabolic (diagnosis, epidemiology, prevention & control)
• Comorbidity
• Female
• Germany (epidemiology)
• Humans
• Male
• Middle Aged
• Osteoporosis (diagnosis, epidemiology, prevention & control)
• Prevalence
• Risk Assessment
• Risk Factors
• Treatment Outcome
• Young Adult