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Rates of Non-vertebral Osteoporotic Fractures in Rheumatoid Arthritis and Postfracture Osteoporosis Care in a Period of Evolving Clinical Practice Guidelines

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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.

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Human and Animal Rights and Informed Consent

This research was approved by the Ethics Review Boards of the Research Institute of the McGill University Health Centre and by the Quebec Commission d’accès à l’information.

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Authors and Affiliations

  1. Faculty of Pharmacy, University of Montreal, Pavillon Jean-Coutu, 2940 chemin de la polytechnique, Montreal, QC, H3C 3J7, Canada

    Jean-Pascal Roussy & Jean Lachaine

  2. Centre Hospitalier Universitaire de Québec, Laval University, Pavillon CHUL, 2705 boulevard Laurier, Quebec, QC, G1V 4G2, Canada

    Louis Bessette

  3. Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, McGill University, A6-1650 Cedar Ave, Montreal, QC, H3A 1A4, Canada

    Sasha Bernatsky

  4. Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, McGill University, Royal Victoria Hospital – V Building (Rm. V2.11), 687 Pine Avenue West, Montreal, QC, H3A 1A1, Canada

    Elham Rahme

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  1. Jean-Pascal Roussy
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Corresponding author

Correspondence to Jean-Pascal Roussy.

Additional information

No funding was received for this research. J.-P. Roussy is an employee of Pfizer. Pfizer did not provide financial support for this study and was not involved in the study design, implementation, and interpretation or the reporting of the results. This work is attributable to the University of Montreal where J.-P. Roussy is a PhD candidate, and the McGill University. E. Rahme is a research scholar funded by Fonds de Recherche en Santé du Québec. In the past 36 months, she received grants and/or consultant fees from Pfizer Canada and Janssen on issues unrelated to the current study. J. Lachaine has received research support from AbbVie, Pfizer Canada, and Novartis on issues unrelated to the current study. L. Bessette and S. Bernatsky have no financial interests to disclose.

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Roussy, JP., Bessette, L., Bernatsky, S. et al. Rates of Non-vertebral Osteoporotic Fractures in Rheumatoid Arthritis and Postfracture Osteoporosis Care in a Period of Evolving Clinical Practice Guidelines. Calcif Tissue Int 95, 8–18 (2014). https://doi.org/10.1007/s00223-014-9856-5

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  • DOI: https://doi.org/10.1007/s00223-014-9856-5

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