title: Osteoporosis management in patients with rheumatoid arthritis: Evidence for improvement.
abstract: OBJECTIVE
  Osteoporosis in patients with rheumatoid arthritis (RA) is increasingly recognized as a major comorbidity. We examined past management patterns for glucocorticoid-induced osteoporosis and attempted to improve care through an educational intervention. The goal was to examine the frequency of osteoporosis management in patients with RA treated at a large academic rheumatology practice.
  
  
  METHODS
  We performed a structured chart review on randomly selected patients seen during 2004 for RA. Osteoporosis management was defined as a bone mineral density test or receipt of a medication for osteoporosis in the prior 24 months. The frequency of osteoporosis management among our study group was assessed. We also examined how glucocorticoid dosage affected osteoporosis management in adjusted models.
  
  
  RESULTS
  We reviewed the records for 193 patients, 99 had not used glucocorticoids in the prior 24 months, and 94 had used them. Of the total study population, 48% had received a bone mineral density test or medication for osteoporosis. Some form of osteoporosis management was present for 64% of patients taking > or =5 mg prednisone for > or =3 months compared with 38% for patients taking none (P = 0.002). Predictors of osteoporosis management included older age, female sex, glucocorticoid dosage, and prior osteoporosis diagnosis or fracture.
  
  
  CONCLUSIONS
  The frequency of osteoporosis management appears to have increased compared with a prior chart review.
authors.affiliation: Division of Pharmacoepidemiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02120, USA. dhsolomon@partners.org
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
authors.forename: Danielle
authors.initials: D
authors.lastname: Cabral
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Patrick
authors.forename: Jack F
authors.initials: JF
authors.lastname: Bukowski
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Coblyn
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000453:epidemiology; D015519:Bone Density; D015897:Comorbidity; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D010024:Osteoporosis / Q000139:chemically induced* / Q000188:drug therapy* / Q000453:epidemiology; D011241:Prednisone / Q000009:adverse effects*; D011787:Quality of Health Care; D012219:Rheumatology / Q000592:standards
chemical_list: D005938:Glucocorticoids; D011241:Prednisone