Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.


Care Gap in Early Inflammatory Arthritis Patients with a High Fracture Risk Identified Using the FRAX Tool

Bykerk1,  Vivian P., Cheng1,  Carly K., Boire2,  Gilles, Pope3,  Janet E., Haraoui4,  Boulos, Hitchon5,  Carol A., Jamal6,  Shahin

Mt Sinai Hospital, Toronto, ON,
CHUS-Sherbrooke University, Sherbrooke,
St Joseph Health Care, London, ON,
Institut de rhumatologie de Montréal, Montreal, QC,
University of Manitoba, Winnipeg, MB,
St. Michael's Hospital, Toronto,
Southlake Regional Health Centre, Newmarket, ON,

Purpose:

A fracture risk assessment tool (FRAX®; http://shef.ac.uk/FRAX) estimates a 10-year absolute risk of sustaining a hip or other major osteoporotic fracture. FRAX® identifies patients at low (<10%), moderate (10–20%) or high (>20%) risk of fracture using validated clinical risk factors ± bone mineral density (BMD) testing. This study determined the frequency of patients with early inflammatory and rheumatoid arthritis (EIA and ERA) at high risk of major osteoporotic fracture using FRAX® and evaluated the care gap in high risk patients.

Method:

239 patients were enrolled since July 2007 in the Canadian Early Arthritis Cohort (CATCH) study, a multi-centre observational prospective "real world" cohort of patients with EIA. Inclusion Criteria: age >16, symptom duration of 6–52 weeks of persistent synovitis, >=2 effused joints or 1 swollen MCP or PIP +>=1 of: positive RF, positive anti-CCP, morning stiffness >45mins, response to NSAIDs, or painful MTP squeeze test. FRAX® was calculated based on ethnicity assuming norms from the United States of America (USA) and United Kingdom (UK), without BMD. History of hip fracture in a parent hip was inconsistently reported in the CATCH standardized questionnaire and assumed to be absent if data were not available.

Results:

Baseline characteristics: mean age 52±15 years, 80% female, 79% RA (ACR criteria), median symptom duration 6.1 months, mean DAS28 ESR 4.9±1.5, 16% treated with oral glucocorticoids. Based on USA norms, patients at high risk vs. low risk had a higher mean age (p<0.011), higher DAS28 (p=0.036), and received more glucocorticoids (p=0.011). DAS28 of patients at moderate risk was greater vs. low risk (p=0.112). The rate of Ca, Vit D and bisphosphonate use did not increase in low to moderate to high risk groups (p=0.05).

Table. FRAX® major osteoporotic fracture risk (n=239)

 Low Risk (<10%)Moderate Risk (10–20%)High Risk (>20%)
 USAUKUSAUKUSAUK
N (%)155 (65%)175 (73%)52 (22%)52 (22%)32 (13%)12 (5%)
Age (mean)44 ± 1247 ± 1364 ± 766 ± 872 ± 879 ± 6
Oral glucocorticoids (base)11.6%25.7%21.2%26.9%31.3%75.0%
Received Ca or Vit D13.6%14.9%19.2%15.4%15.6%16.7%
Received a Bisphosphonate4.5%4.0%3.9%7.7%9.4%8.3%
DAS28 ESR (base mean)4.9 ± 1.54.8 ± 1.55.3 ± 1.55.0 ± 1.55.5 ± 1.05.3 ± 1.2

Conclusion:

FRAX® identified 5–13% of patients at high risk using a conservative analysis, as being older, having higher disease activity and more frequent glucocorticoid use at baseline compared to patients at low risk. Despite awareness that classic risk factors are associated with high risk, a very low proportion of patients are being treated with supplemental Ca, Vit D and bisphosphonates. These data highlight the need to identify and modify fracture risk in patients presenting with EIA/ERA.

To cite this abstract, please use the following information:
Bykerk, Vivian P., Cheng, Carly K., Boire, Gilles, Pope, Janet E., Haraoui, Boulos, Hitchon, Carol A., et al; Care Gap in Early Inflammatory Arthritis Patients with a High Fracture Risk Identified Using the FRAX Tool [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1193
DOI: 10.1002/art.26267

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