Korean J Intern Med.  2014 Jul;29(4):509-515.

Are glucocorticoid-induced osteoporosis recommendations sufficient to determine antiosteoporotic treatment for patients with rheumatoid arthritis?

• Lee JH
• Cho SK
• Han M
• Kim D
• Bae SC
• Sung YK

Abstract

BACKGROUND/AIMS
We investigated differences in identifying candidates for antiosteoporotic treatment in rheumatoid arthritis (RA) patients according to two available clinical guidelines.
METHODS
We prospectively enrolled 100 female patients aged 50 years or older with RA who visited Hanyang University Hospital for periodic examinations between April 2011 and August 2011. We applied the glucocorticoid-induced osteoporosis (GIOP) recommendations and the National Osteoporosis Foundation (NOF) guidelines to RA patients and examined agreement between the guidelines for identifying candidates for antiosteoporotic treatment. We also analyzed the impact of screening vertebral fractures (VFs) in determining the treatment of osteoporosis in RA patients.
RESULTS
The 57 patients taking glucocorticoids were classified into high-risk (n = 23), medium-risk (n = 16), and low-risk (n = 18) groups according to the GIOP recommendations. Based on the NOF guidelines, 36 of 57 patients were candidates for antiosteoporotic treatment and the agreement between two guidelines was high (kappa = 0.76). Two of the 18 patients in the low-risk group and 19 of 43 patients not eligible per the GIOP recommendations were classified as candidates for antiosteoporotic treatment by the NOF guidelines.
CONCLUSIONS
In determining antiosteoporotic treatment for RA patients, using only the GIOP recommendations is insufficient. Application of the NOF guidelines in patients not eligible for or classified into the low-risk group per the GIOP recommendations and screening for VFs may be helpful in deciding on antiosteoporotic treatment in RA patients.

Keyword

Glucocorticoids; Osteoporosis; Arthritis, rheumatoid; Guideline

MeSH Terms

Aged
Arthritis, Rheumatoid/diagnosis/*drug therapy
Bone Density Conservation Agents/*therapeutic use
*Decision Support Techniques
Female
Glucocorticoids/*adverse effects
Hospitals, University
Humans
Middle Aged
Osteoporosis/*chemically induced/diagnosis/*prevention & control
Osteoporotic Fractures/chemically induced/prevention & control
Patient Selection
Practice Guidelines as Topic
Predictive Value of Tests
Prospective Studies
Republic of Korea
Risk Assessment
Risk Factors
Spinal Fractures/chemically induced/prevention & control
Bone Density Conservation Agents
Glucocorticoids