Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Fracture Risk Assessment and Osteoporosis Treatment Disparities in 4027 Japanese Patients with Rheumatoid Arthritis.

Furuya2,  Takefumi, Hosoi1,  Takayuki, Inoue3,  Eisuke, Taniguchi3,  Atuo, Momohara3,  Shigeki, Yamanaka4,  Hisashi

Department of Clinical Research and Development, National Center for Geriatrics and Gerontology
Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
Institute of Rheumatology, Tokyo Women's Medical University
Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan

Purpose:

We previously reported that osteoporosis appeared to be undertreated in Japanese patients with rheumatoid arthritis (RA) (J Rheumatol 2007). Using clinical risk factors from the World Health Organization (WHO) Fracture Risk Assessment (FRAX) tool and recommendations from the National Osteoporosis Foundation (NOF), we evaluated fracture risk and osteoporosis treatment in a cohort of Japanese RA patients.

Methods:

Among patients participating in a single-institute, prospective observational cohort study of Japanese RA patents, namely IORRA (Institute of Rheumatology Rheumatoid Arthritis), 4027 (>=40 years of age, 84% female, median age 61 yrs) responded to questions related to fracture risks in October or November 2008. The WHO-FRAX tool without bone mineral density estimated 10-year hip fracture risk and 10-year risk of a major osteoporosis fracture. Multivariable logistic regression evaluated the association between taking any osteoporosis medications and fracture risk, controlling for potential confounders.

Results:

Among women (n = 3376), 100% and 82%>= 70 years of age (n = 700), 56% and 23% 60–69 years of age (n = 1252), 5% and 2% 50–59 years of age (n = 933), and 0% and 0% 40–49 years of age (n = 491) were identified as having a 10-year hip fracture risk >=3% and a 10-year risk of a major osteoporosis fracture >=20%, respectively. Among men (n = 651), 93% and 14%>= 70 years of age (n =176), 26% and 0.4 % 60–69 years of age (n = 233), 0% and 0% 50–59 years of age (n = 171), and 0% and 0% 40–49 years of age (n = 71) were identified as having a 10-year hip fracture risk >=3% and a 10-year risk of a major osteoporosis fracture >=20%, respectively. Multivariate models identified corticosteroid use (odds ratios (OR) 1.89, 95% confidence interval (CI) 1.50–2.38), Japanese health assessment questionnaire (HAQ) scores (OR 1.75, 95% CI 1.53–2.01), daily prednisolone dose (mg/day) (OR 1.12, 95% CI 1.08–1.17), age (OR 1.06, 95% CI 1.05–1.07), body mass index (kg/m2) (OR 0.92, 95% CI 0.89–0.94), and male gender (OR 0.25, 95% CI 0.19–0.33) as significantly associated (p < 0.01) with taking any osteoporosis medications. Among the patients with a 10-year hip fracture risk >=3% or a 10-year risk of a major osteoporosis fracture >=20% (n = 1685, 41.8%), only 50.1% (n = 844) and 36.0% (n = 607) reported taking any osteoporosis medications and taking bisphosphonates, respectively.

Conclusions:

The WHO-FRAX tool identified a substantial proportion of Japanese elderly RA patients who had a high risk of hip and major osteoporosis fractures and for whom the 2008 NOF guidelines recommended treatment. A substantial gap exists between the 2008 NOF treatment guidelines based on fracture risk and osteoporosis treatment in Japanese RA patients. The FRAX tool appears useful for assessing risk and identifying high-risk persons in need of additional evaluation.

To cite this abstract, please use the following information:
Furuya, Takefumi, Hosoi, Takayuki, Inoue, Eisuke, Taniguchi, Atuo, Momohara, Shigeki, Yamanaka, Hisashi; Fracture Risk Assessment and Osteoporosis Treatment Disparities in 4027 Japanese Patients with Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :968
DOI: 10.1002/art.28735

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