RESEARCH - Care gap in patients with early arthritis with high fracture risk identified by FRAX

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Journal of Rheumatology

Nov 2010

Care Gap in Patients with Early Inflammatory Arthritis with a High

Fracture Risk Identified Using FRAX®

CARLY K. CHENG, HEATHER McDONALD-BLUMER, GILLES BOIRE, JANET E. POPE,

BOULOS HARAOUI, CAROL A. HITCHON, CARTER THORNE, YE SUN and VIVIAN P.

BYKERK

+ Author Affiliations

From the Division of Rheumatology, Mount Sinai Hospital; University of

Toronto, Toronto, Ontario; Université de Sherbrooke, Sherbrooke,

Quebec; Schulich School of Medicine and Dentistry, University of

Western Ontario, London, Ontario; Université de Montréal, Montréal,

Quebec; University of Manitoba, Winnipeg, Manitoba; and Southlake

Regional Health Centre, Newmarket, Ontario, Canada.

C.K. Cheng, HBSc, Mount Sinai Hospital, University of Toronto; H.

Mc-Blumer, MD, MSc, FRCPC, Mount Sinai Hospital, University

Health Network, University of Toronto; G. Boire, MD, MSc, Professor,

Université de Sherbrooke; J.E. Pope, MD, MPH, FRCPC, Professor,

Schulich School of Medicine and Dentistry, University of Western

Ontario; B. Haraoui, MD, FRCPC, Associate Professor of Medicine,

Université de Montréal; C.A. Hitchon, MD, Associate Professor,

Department of Medicine, Section of Rheumatology, University of

Manitoba; C. Thorne, MD, Director, The Arthritis Program, Southlake

Regional Health Centre; Y. Sun, PhD, Biostatistician, University

Health Network, Mount Sinai Hospital; V.P. Bykerk, MD, Assistant

Professor, University of Toronto, Instructor, Harvard University,

Division of Rheumatology, Mount Sinai Hospital.

Abstract

Objective. To determine the proportion of patients with early

inflammatory arthritis in a Canadian cohort who are at high risk for a

major osteoporotic fracture using the Fracture Risk Assessment Tool

(FRAX®), and to determine if a care gap exists in high-risk patients.

Methods. FRAX was applied to 238 patients enrolled in the Canadian

Early Arthritis Cohort (CATCH) study based on norms from the United

States and the United Kingdom, without the use of bone mineral density

measurements.

Results. FRAX identified 5%–13% of patients at high risk for fracture,

using a conservative analysis. Based on US norms, there was a

significant correlation between increasing fracture risk groups and

oral glucocorticoid use (p = 0.012) and baseline erosions (p = 0.040).

Calcium or vitamin D use did not vary among the different fracture

risk groups (p = NS), nor did bisphosphonate use (p = NS). The Disease

Activity Score with 28 joint count in the high-risk group was

significantly higher compared to the low-risk group (p = 0.048).

Conclusion. Patients at increased risk had higher disease activity,

more frequent glucocorticoid use, and more baseline erosions compared

to patients at low risk. A care gap exists, in that a very low

proportion of patients at high risk are being treated with calcium,

vitamin D, and/or bisphosphonates. A higher fracture risk was

calculated in our cohort using the US FRAX calculation tool compared

to the UK calculation tool. These data highlight the need to identify

and modify fracture risk in patients with early inflammatory

arthritis.

http://jrheum.org/content/37/11/2221.abstract

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