Adherence and efficacy of screening for low bone mineral density among ulcerative colitis patients treated with corticosteroids.
OBJECTIVE
Ulcerative colitis (UC) is associated with an increased risk of metabolic bone disease and fragility fractures. The aim of this study was to assess the adherence to the guidelines issued by the American Gastroenterology Association (AGA) for the screening for low bone density in UC patients and to assess the benefits of dual-energy X-ray absorptiometry (DXA) screening among corticosteroid (CS)-treated UC patients.


METHODS
Nationwide Veterans Affairs system (VA) data were obtained. UC patients followed up in the VA between 2001 and 2011 and the occurrence of fragility fractures were identified using International Classification of Diseases, Ninth Revision codes. Exposure to CSs was assessed using pharmacy data. DXA screening was assessed using the VA procedure database. Post DXA screening, medication use was also assessed from the pharmacy database. Cox regression analysis was performed to calculate the hazard ratio (HR) of fragility fractures among those patients who received DXA compared with those who did not.


RESULTS
We included 5,736 patients. Among them, 80 (1.4%) patients suffered from fragility fractures during the follow-up period. Overall adherence rate to AGA guidelines was 23%. Adherence rate was highest among postmenopausal women (48%) and lowest among men above 50 years of age (20%). UC patients who received DXA screening were more likely to be started on bisfosfonates (P<0.001), calcitonin (P<0.001), vitamin D, and calcium (P<0.001) compared with those who did not receive screening. Those who received DXA screening were half as likely (HR=0.5, 0.3-0.9, P=0.03) to develop fragility fractures as compared with those who did not receive screening. The benefits were more prominent among those with higher CS exposure.


CONCLUSIONS
Rates of DXA screening were low among CS-treated UC patients. Those who received DXA screening were more likely to be started on antiresorptive therapy and supplemental medications and had a 50% reduction in the risk of fragility fractures. More efforts should be directed toward raising the adherence to AGA guidelines and the awareness of DXA benefits.
1] Southeast Louisiana Veterans Health Care System, Section of Gastroenterology, Department of Internal Medicine, New Orleans, Louisiana, USA [2] Section of Gastroenterology and Hepatology, Department of Internal Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, USA.
Nabeel
N
Khan
1] Southeast Louisiana Veterans Health Care System, Section of Gastroenterology, Department of Internal Medicine, New Orleans, Louisiana, USA [2] Section of Gastroenterology and Hepatology, Department of Internal Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, USA [3] Department of Internal Medicine, University of Florida, Gainesville, Florida, USA.
Ali M
AM
Abbas
1] Southeast Louisiana Veterans Health Care System, Section of Gastroenterology, Department of Internal Medicine, New Orleans, Louisiana, USA [2] Section of Gastroenterology and Hepatology, Department of Internal Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, USA [3] Department of Epidemiology, Louisiana State University Health Science Center, New Orleans, Louisiana, USA.
Rawaa M
RM
Almukhtar
1] Southeast Louisiana Veterans Health Care System, Section of Gastroenterology, Department of Internal Medicine, New Orleans, Louisiana, USA [2] Section of Gastroenterology and Hepatology, Department of Internal Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, USA.
Elisabeth B
EB
Cole
Section of Endocrinology, Department of Internal Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, USA.
Amna N
AN
Khan
D015502:Absorptiometry, Photon / Q000706:statistics & numerical data*; D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010024:Osteoporosis / Q000000981:diagnostic imaging* / Q000209:etiology; D058866:Osteoporotic Fractures / Q000209:etiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D058014:Veterans Health
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents