title: Risk factors for osteoporosis and fracture in patients attending rheumatology outpatient clinics.
abstract: BACKGROUND
  Bone mineral density (BMD) using dual energy X-ray absorptiometry (DXA) scanning is the best predictor of osteoporotic fracture but may not be cost effective for all patient groups. Risk factors (RF) other than BMD may be useful for fracture prediction.
  
  
  OBJECTIVE
  To assess the prevalence of RF for osteoporosis (OP) and fracture in patients attending a public hospital rheumatology clinic and to document physician awareness of these RF.
  
  
  METHODS
  Two hundred and twenty rheumatology outpatients completed a self-administered questionnaire pertaining to known RF for OP and fracture. Initiatives were documented by the treating rheumatologist.
  
  
  RESULTS
  One hundred and fifty-four females and 66 males completed questionnaires: 57% had an inflammatory disorder and 32% had received significant glucocorticoid therapy. Forty-five (68%) males and 126 (82%) females had three or more RF for OP and fracture. Diagnosis of rheumatoid arthritis or connective tissue disorder (CTD) was the variable most significantly associated with increasing numbers of RF. Antiosteoporotic medication (AOM) use at assessment (64/219, 29.2%) was accounted for primarily by the use of hormone replacement therapy in females between 45-54 years. Prednisolone use predicted intervention in 103 (48%) patients.
  
  
  CONCLUSIONS
  Many rheumatology outpatients have multiple RF for OP and fracture. Infrequent AOM use could be explained by inadequate awareness of high risk patients and the lack of an ideal long term agent. With restricted outpatient resources, the feasibility of identifying high risk patients for OP and fracture would increase if the hierarchical status of RF was better understood.
authors.affiliation: Department of Rheumatology, Royal Melbourne Hospital, Vic.
authors.forename: C A
authors.initials: CA
authors.lastname: Brand
authors.forename: D
authors.initials: D
authors.lastname: Jolley
authors.forename: M
authors.initials: M
authors.lastname: Tellus
authors.forename: K D
authors.initials: KD
authors.lastname: Muirden
authors.forename: J D
authors.initials: JD
authors.lastname: Wark
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D010044:Outpatient Clinics, Hospital; D015995:Prevalence; D012216:Rheumatic Diseases / Q000188:drug therapy; D012219:Rheumatology; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D005938:Glucocorticoids