title: Care gap in patients with early inflammatory arthritis with a high fracture risk identified using FRAX(®).
abstract: OBJECTIVE
  To determine the proportion of patients with early inflammatory arthritis in a Canadian cohort who are at high risk for a major osteoporotic fracture using the Fracture Risk Assessment Tool (FRAX(®)), and to determine if a care gap exists in high-risk patients.
  
  
  METHODS
  FRAX was applied to 238 patients enrolled in the Canadian Early Arthritis Cohort (CATCH) study based on norms from the United States and the United Kingdom, without the use of bone mineral density measurements.
  
  
  RESULTS
  FRAX identified 5%-13% of patients at high risk for fracture, using a conservative analysis. Based on US norms, there was a significant correlation between increasing fracture risk groups and oral glucocorticoid use (p = 0.012) and baseline erosions (p = 0.040). Calcium or vitamin D use did not vary among the different fracture risk groups (p = NS), nor did bisphosphonate use (p = NS). The Disease Activity Score with 28 joint count in the high-risk group was significantly higher compared to the low-risk group (p = 0.048).
  
  
  CONCLUSIONS
  Patients at increased risk had higher disease activity, more frequent glucocorticoid use, and more baseline erosions compared to patients at low risk. A care gap exists, in that a very low proportion of patients at high risk are being treated with calcium, vitamin D, and/or bisphosphonates. A higher fracture risk was calculated in our cohort using the US FRAX calculation tool compared to the UK calculation tool. These data highlight the need to identify and modify fracture risk in patients with early inflammatory arthritis.
authors: Division of Rheumatology, Mount Sinai Hospital, 60 Murray Street, 2nd floor, Toronto, Ontario M5T 3L9, Canada.
authors: Carly K
authors: CK
authors: Cheng
authors: Heather
authors: H
authors: McDonald-Blumer
authors: Gilles
authors: G
authors: Boire
authors: Janet E
authors: JE
authors: Pope
authors: Boulos
authors: B
authors: Haraoui
authors: Carol A
authors: CA
authors: Hitchon
authors: Carter
authors: C
authors: Thorne
authors: Ye
authors: Y
authors: Sun
authors: Vivian P
authors: VP
authors: Bykerk
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001168:Arthritis / Q000150:complications*; D001835:Body Weight; D015519:Bone Density; D002170:Canada; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications*; D058866:Osteoporotic Fractures / Q000209:etiology*; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires