title: Rates of non-vertebral osteoporotic fractures in rheumatoid arthritis and postfracture osteoporosis care in a period of evolving clinical practice guidelines.
abstract: In 2002, guidelines for the management of osteoporosis were published by Osteoporosis Canada and widely disseminated. We aimed to assess if those guidelines had any impact on clinical practice and ultimately on fracture rates in rheumatoid arthritis (RA). This was an observational study using the Quebec healthcare databases. To quantify the use of osteoporosis drugs, hormone replacement therapy (HRT), bone mineral density (BMD) testing, and fracture rates, quarterly age-standardized rates between 1998 and 2008 were calculated. A time series approach was used to predict fracture rates from 2003 onward, based on the earlier data. The provision of postfracture osteoporosis care, as defined by the initiation of osteoporosis drugs, HRT, or BMD testing, was examined; and logistic regressions identified factors associated with care. The study population in each quarter was mainly composed of older women. The use of osteoporosis drugs and BMD testing increased over the study period. The actual fracture rates from 2003 onward fell within the projected rates and their 95 % CI indicating no reduction. A total of 1,279 subjects were included in the postfracture care analysis. Over time, the likelihood of receiving osteoporosis care increased by 64 % (OR = 1.64, 95 % CI 1.27-2.11), and the two strongest predictors of care were female gender and corticosteroid use. Over our study period, fracture rates remained stable in this RA population. However, the use of osteoporosis drugs, BMD testing, and provision of postfracture osteoporosis care improved, which may result from gradual adoption of guidelines.
authors.affiliation: Faculty of Pharmacy, University of Montreal, Pavillon Jean-Coutu, 2940 chemin de la polytechnique, Montreal, QC, H3C 3J7, Canada, jean-pascal.roussy@live.com.
authors.forename: Jean-Pascal
authors.initials: JP
authors.lastname: Roussy
authors.forename: Louis
authors.initials: L
authors.lastname: Bessette
authors.forename: Sasha
authors.initials: S
authors.lastname: Bernatsky
authors.forename: Elham
authors.initials: E
authors.lastname: Rahme
authors.forename: Jean
authors.initials: J
authors.lastname: Lachaine
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications*; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002170:Canada; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D017410:Practice Guidelines as Topic
chemical_list: D050071:Bone Density Conservation Agents