For the past decade, rheumatoid arthritis and osteoarthritis patients have received suboptimal screenings and treatment for osteoporosis, despite a higher risk for that disease, which causes brittle and weak bones. That’s according to a new study published in Arthritis Care & Research.
“Patients should know how bad the consequences are of having a fracture and should be motivated to ensure regular screening for osteoporosis and treatment as recommended,” said Kaleb Michaud, senior study author and an associate professor in the University of Nebraska Medical Center’s rheumatology division.
With reductions in use of steroids, researchers hoped to see also a decrease in risk for fracture and osteoporosis. “But there is still an inherent increase in risk that comes from having RA,” Michaud told CreakyJoints. (He provided Medpage with similar comments.)
“This, like many other conditions’ screening, can create uncertainty about who is responsible for ensuring this screening is done — rheumatologist, primary care physician, or other specialist,” he added.
[Read more about osteoporosis symptoms.]
The paper’s first author, Gulsen Ozen, a researcher at UNMC and at Turkey’s Marmara University, said that the new research demonstrates that osteoporosis screening and treatment for rheumatoid arthritis and osteoarthritis patients hasn’t improved over the last decade.
“The consequences of this declining suboptimal osteoporosis care is worrying, as OP is still frequent in RA patients, regardless of glucocorticoid use, and hip fracture rates are not declining anymore in the last three years,” Dr. Ozen said. “We think the message of our research for patients is being more aware of the adverse consequences of fractures, understanding the importance of fracture risk assessment, and being more willing to participate in osteoporosis screening and treatment strategies.”
She and colleagues also hope that their demonstration of an increasing gap in osteoporosis care will furnish physicians with insights about what has caused that suboptimal fracture risk assessment and management practice. “We also hope that physicians identifying their concerns can help addressing patients’ concerns as well,” she said, “and consequently improve osteoporosis care.”
[Learn more about osteoporosis treatment.]
The reasons for that subprime osteoporosis care for at-risk rheumatoid arthritis patients aren’t fully understood, according to Dr. Ozen. There are barriers both for patients — who aren’t necessarily aware of the risk of fracture, who may be concerned about osteoporosis medications, and may not want to take on added drugs and costs — and for physicians. The latter often lack experience and time, and focus more on diseases activity and comorbidities like cancer, heart disease, or stroke, especially for RA patients receiving biologics, she said.
Dr. Ozen and colleagues don’t have direct evidence, but they believe that several factors motivated this decline in osteoporosis care. Those include: cuts in Medicare reimbursement for dual-energy X-ray absorptiometry (DXA) in 2007; the U.S. Food and Drug Administration’s 2006 warning for jaw bone necrosis (osteonecrosis) with bisphosphonates; 2007 publications about atrial fibrillation and 2010 publications about an association between atypical femoral fractures and long-term bisphosphonate treatment; and “several negative critical media reports about these issues,” she said.
“In order to improve osteoporosis care, these obstacles should be overcome by informing the community about the significant cost, morbidity, and mortality outcomes of osteoporotic fractures,” Dr. Ozen said, “and better disseminating the message about risk benefit ratio of osteoporosis medications.”
[Find out more about causes of osteoporosis.]
Osteoporosis risk doubles due to chronic inflammation, accelerated aging, and hormonal changes, disability and immobility caused by the disease, and frequent use of certain medications, such as glucocorticoids, according to Dr. Ozen.
Even minor trauma, such as a fall from a standing height or lower, can cause fractures for osteoporosis patients, and those fractures are often seen in the hip, vertebra, or arm. Those fractures “significantly contribute to the disability, functional loss, morbidity, death, and health-related costs of rheumatoid arthritis,” Dr. Ozen said.
“Considering the frequent occurrence of other diseases in RA, such as heart diseases, death rates from osteoporotic hip fractures are substantially higher in RA patients than the general population,” she added. “Therefore, it is very important to appropriately assess the osteoporosis/fracture risk and apply preventive and therapeutic care to these patients.”