title: [Diagnosis and treatment of osteoporosis and rheumatoid arthritis in accordance with German guidelines. Results of a survey of patients, primary care physicians and rheumatologists].
abstract: In a cross-sectional study the prevalence of osteoporosis and osteopenia in patients with rheumatoid arthritis (ORA study) was investigated. Additionally, patients, their family doctors and rheumatologists were surveyed on their awareness of osteoporosis in RA, prevention, diagnosis, treatment and use of guidelines.In the years 2005 and 2006 a total of 532 patients with RA (98 men, 434 women) aged 23-87 years were consecutively recruited from 9 German centers for rheumatology. Clinical examination included a detailed documentation of osteoporosis medication. Dual-energy X-ray absorptiometry (DXA) was used to measure bone mineral density (BMD) at the lumbar spine and neck of the femur. Questionnaires on osteoporosis were sent to 119 family doctors (87 men, 32 women) and 44 rheumatologists (30 men, 14 women).The survey showed that rheumatologists had a higher awareness of osteoporosis in RA and compared to family doctors they estimated a higher frequency and tested RA patients more often for osteoporosis. In line with osteoporosis guidelines rheumatologists and family doctors saw an indication for densitometry in RA patients on steroid therapy and/or low intensity trauma fractures. In contrast to the 2006 recommendations of osteoporosis guidelines 50% of family doctors and rheumatologists preferred bisphosphonate off-label-therapy for premeopausal women with RA and comorbid glucocorticoid-induced osteoporosis. On the other hand 50% of premenopausal RA patients with osteoporosis did not receive any osteoporosis medication.The survey revealed a high degree of guideline compliance in diagnosing osteoporosis in RA but deficits were observed in the administration of osteoporosis medication, especially in premenopausal women.
authors.affiliation: Hochschule Fulda, Fulda, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Heberlein
authors.forename: W
authors.initials: W
authors.lastname: Demary
authors.forename: H
authors.initials: H
authors.lastname: Bloching
authors.forename: J
authors.initials: J
authors.lastname: Braun
authors.forename: F
authors.initials: F
authors.lastname: Buttgereit
authors.forename: R
authors.initials: R
authors.lastname: Dreher
authors.forename: C
authors.initials: C
authors.lastname: Kuhn
authors.forename: U
authors.initials: U
authors.lastname: Lange
authors.forename: A
authors.initials: A
authors.lastname: Zink
authors.forename: H
authors.initials: H
authors.lastname: Zeidler
authors.forename: H
authors.initials: H
authors.lastname: Häntzschel
authors.forename: H
authors.initials: H
authors.lastname: Raspe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use; D002118:Calcium / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005260:Female; D005858:Germany; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use; D019983:Guideline Adherence; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D010353:Patient Education as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012219:Rheumatology; D012307:Risk Factors; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D005938:Glucocorticoids; D014807:Vitamin D; D002118:Calcium