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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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References

  1. Michaud K, Wolfe F (2007) Comorbidities in rheumatoid arthritis. Best Pract Res Clin Rheumatol 21:885–906

    Article  PubMed  Google Scholar 

  2. Vosse D, de Vlam K (2009) Osteoporosis in rheumatoid arthritis and ankylosing spondylitis. Clin Exp Rheumatol 27 Suppl:S62–S67

    Google Scholar 

  3. Weiss RJ, Wick MC, Ackermann PW, Montgomery SM (2010) Increased fracture risk in patients with rheumatic disorders and other inflammatory diseases—a case–control study with 53,108 patients with fracture. J Rheumatol 37:2247–2250

    Article  PubMed  Google Scholar 

  4. Wright NC, Lisse JR, Walitt BT, Eaton CB, Chen Z (2011) Arthritis increases the risk for fractures—results from the Women’s Health Initiative. J Rheumatol 38:1680–1688

    Article  PubMed Central  PubMed  Google Scholar 

  5. Papaioannou A, Kennedy CC, Ioannidis G, Sawka A, Hopman WM, Pickard L, Brown JP, Josse RG, Kaiser S, Anastassiades T, Goltzman D, Papadimitropoulos M, Tenenhouse A, Prior JC, Olszynski WP, Adachi JD (2009) The impact of incident fractures on health-related quality of life: 5 years of data from the Canadian Multicentre Osteoporosis Study. Osteoporos Int 20:703–714

    Article  CAS  PubMed  Google Scholar 

  6. Jean S, Bessette L, Belzile EL, Davison KS, Candas B, Morin S, Dodin S, Brown JP (2013) Direct medical resource utilization associated with osteoporosis-related nonvertebral fractures in postmenopausal women. J Bone Miner Res 28:360–371

    Article  PubMed  Google Scholar 

  7. Brown JP, Josse RG (2002) 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 167 Suppl:S1–S34

    Google Scholar 

  8. Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, Hanley DA, Hodsman A, Jamal SA, Kaiser SM, Kvern B, Siminoski K, Leslie WD (2010) 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 182:1864–1873

    Article  PubMed Central  PubMed  Google Scholar 

  9. American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis (2001) Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 update. Arthritis Rheum 44:1496–1503

    Article  Google Scholar 

  10. Grossman JM, Gordon R, Ranganath VK, Deal C, Caplan L, Chen W, Curtis JR, Furst DE, McMahon M, Patkar NM, Volkmann E, Saag KG (2010) American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res (Hoboken) 62:1515–1526

    Article  Google Scholar 

  11. Régie de l’assurance maladie du Québec (20112) Data and statistics. http://www.ramq.gouv.qc.ca/en/data-statistics/Pages/data-statistics.aspx. Cited 1 Aug 2012

  12. Tamblyn R, Lavoie G, Petrella L, Monette J (1995) The use of prescription claims databases in pharmacoepidemiological research: the accuracy and comprehensiveness of the prescription claims database in Quebec. J Clin Epidemiol 48:999–1009

    Article  CAS  PubMed  Google Scholar 

  13. Jean S, Candas B, Belzile E, Morin S, Bessette L, Dodin S, Brown JP (2012) Algorithms can be used to identify fragility fracture cases in physician-claims databases. Osteoporos Int 23:483–501

    Article  CAS  PubMed  Google Scholar 

  14. Roussy JP, Bessette L, Bernatsky S, Rahme E, Lachaine J (2013) Biologic disease-modifying anti-rheumatic drugs and the risk of nonvertebral osteoporotic fractures in patients with rheumatoid arthritis aged 50 years and over. Osteoporos Int 24:2483–2492

    Article  PubMed  Google Scholar 

  15. Woolcott JC, Richardson KJ, Wiens MO, Patel B, Marin J, Khan KM, Marra CA (2009) Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med 169:1952–1960

    Article  PubMed  Google Scholar 

  16. Fraser LA, Leslie WD, Targownik LE, Papaioannou A, Adachi JD (2013) The effect of proton pump inhibitors on fracture risk: report from the Canadian Multicenter Osteoporosis Study. Osteoporos Int 24:1161–1168

    Article  CAS  PubMed  Google Scholar 

  17. Eom CS, Lee HK, Ye S, Park SM, Cho KH (2012) Use of selective serotonin reuptake inhibitors and risk of fracture: a systematic review and meta-analysis. J Bone Miner Res 27:1186–1195

    Article  CAS  PubMed  Google Scholar 

  18. Lyngstad-Brechan MA, Tauboll E, Nakken KO, Gjerstad L, Godang K, Jemtland R, Bollerslev J (2008) Reduced bone mass and increased bone turnover in postmenopausal women with epilepsy using antiepileptic drug monotherapy. Scand J Clin Lab Invest 68:759–766

    Article  CAS  PubMed  Google Scholar 

  19. Buehring B, Viswanathan R, Binkley N, Busse W (2013) Glucocorticoid-induced osteoporosis: an update on effects and management. J Allergy Clin Immunol 132:1019–1030

    Article  CAS  PubMed  Google Scholar 

  20. Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619

    Article  CAS  PubMed  Google Scholar 

  21. Leslie WD, Lix LM, Yogendran MS (2011) Validation of a case definition for osteoporosis disease surveillance. Osteoporos Int 22:37–46

    Article  CAS  PubMed  Google Scholar 

  22. Roussy JP, Bessette L, Rahme E, Bernatsky S, Legare J, Lachaine J (2013) Rheumatoid arthritis pharmacotherapy and predictors of disease-modifying anti-rheumatic drug initiation in the early years of biologic use in Quebec, Canada. Rheumatol Int 34:75–83

    Article  Google Scholar 

  23. Kawai VK, Grijalva CG, Arbogast PG, Curtis JR, Solomon DH, Delzell E, Chen L, Ouellet-Hellstrom R, Herrinton L, Liu L, Mitchell EF Jr, Stein CM, Griffin MR (2013) Initiation of tumor necrosis factor alpha antagonists and risk of fractures in patients with selected rheumatic and autoimmune diseases. Arthritis Care Res (Hoboken) 65:1085–1094

    Article  CAS  Google Scholar 

  24. Kim SY, Schneeweiss S, Liu J, Solomon DH (2012) Effects of disease-modifying antirheumatic drugs on nonvertebral fracture risk in rheumatoid arthritis: a population-based cohort study. J Bone Miner Res 27:789–796

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Jaglal SB, Weller I, Mamdani M, Hawker G, Kreder H, Jaakkimainen L, Adachi JD (2005) Population trends in BMD testing, treatment, and hip and wrist fracture rates: are the hip fracture projections wrong? J Bone Miner Res 20:898–905

    Article  PubMed  Google Scholar 

  26. Leslie WD, O’Donnell S, Jean S, Lagace C, Walsh P, Bancej C, Morin S, Hanley DA, Papaioannou A (2009) Trends in hip fracture rates in Canada. JAMA 302:883–889

    Article  CAS  PubMed  Google Scholar 

  27. Leslie WD, Sadatsafavi M, Lix LM, Azimaee M, Morin S, Metge CJ, Caetano P (2011) Secular decreases in fracture rates 1986–2006 for Manitoba, Canada: a population-based analysis. Osteoporos Int 22:2137–2143

    Article  CAS  PubMed  Google Scholar 

  28. Cheng CK, McDonald-Blumer H, Boire G, Pope JE, Haraoui B, Hitchon CA, Thorne C, Sun Y, Bykerk VP (2010) Care gap in patients with early inflammatory arthritis with a high fracture risk identified using FRAX®. J Rheumatol 37:2221–2225

    Article  PubMed  Google Scholar 

  29. Aizer J, Reed G, Onofrei A, Harrison MJ (2009) Predictors of bone density testing in patients with rheumatoid arthritis. Rheumatol Int 29:897–905

    Article  CAS  PubMed  Google Scholar 

  30. Solomon DH, Katz JN, Cabral D, Patrick AR, Bukowski JF, Coblyn JS (2006) Osteoporosis management in patients with rheumatoid arthritis: evidence for improvement. Arthritis Rheum 55:873–877

    Article  CAS  PubMed  Google Scholar 

  31. Bessette L, Jean S, Davison KS, Roy S, Ste-Marie LG, Brown JP (2009) Factors influencing the treatment of osteoporosis following fragility fracture. Osteoporos Int 20:1911–1919

    Article  CAS  PubMed  Google Scholar 

  32. Fraser LA, Ioannidis G, Adachi JD, Pickard L, Kaiser SM, Prior J, Brown JP, Hanley DA, Olszynski WP, Anastassiades T, Jamal S, Josse R, Goltzman D, Papaioannou A (2011) Fragility fractures and the osteoporosis care gap in women: the Canadian Multicentre Osteoporosis Study. Osteoporos Int 22:789–796

    Article  PubMed  Google Scholar 

  33. Leslie WD, Giangregorio LM, Yogendran M, Azimaee M, Morin S, Metge C, Caetano P, Lix LM (2012) A population-based analysis of the post-fracture care gap 1996-2008: the situation is not improving. Osteoporos Int 23:1623–1629

    Article  CAS  PubMed  Google Scholar 

  34. Papaioannou A, Kennedy CC, Ioannidis G, Gao Y, Sawka AM, Goltzman D, Tenenhouse A, Pickard L, Olszynski WP, Davison KS, Kaiser S, Josse RG, Kreiger N, Hanley DA, Prior JC, Brown JP, Anastassiades T, Adachi JD (2008) The osteoporosis care gap in men with fragility fractures: the Canadian Multicentre Osteoporosis Study. Osteoporos Int 19:581–587

    Article  CAS  PubMed  Google Scholar 

  35. Vanasse A, Dagenais P, Niyonsenga T, Gregoire JP, Courteau J, Hemiari A (2005) Bone mineral density measurement and osteoporosis treatment after a fragility fracture in older adults: regional variation and determinants of use in Quebec. BMC Musculoskelet Disord 6:33

    Article  PubMed Central  PubMed  Google Scholar 

  36. Sampalis JS, Adachi JD, Rampakakis E, Vaillancourt J, Karellis A, Kindundu C (2012) Long-term impact of adherence to oral bisphosphonates on osteoporotic fracture incidence. J Bone Miner Res 27:202–210

    Article  CAS  PubMed  Google Scholar 

  37. Auais M, Morin S, Nadeau L, Finch L, Mayo N (2013) Changes in frailty-related characteristics of the hip fracture population and their implications for healthcare services: evidence from Quebec, Canada. Osteoporos Int 24:2713–2724

    Article  CAS  PubMed  Google Scholar 

  38. Huot L, Couris CM, Tainturier V, Jaglal S, Colin C, Schott AM (2008) Trends in HRT and anti-osteoporosis medication prescribing in a European population after the WHI study. Osteoporos Int 19:1047–1054

    Article  CAS  PubMed  Google Scholar 

  39. Curtis JR, Mudano AS, Solomon DH, Xi J, Melton ME, Saag KG (2009) Identification and validation of vertebral compression fractures using administrative claims data. Med Care 47:69–72

    Article  PubMed Central  PubMed  Google Scholar 

  40. Lix LM, Azimaee M, Osman BA, Caetano P, Morin S, Metge C, Goltzman D, Kreiger N, Prior J, Leslie WD (2012) Osteoporosis-related fracture case definitions for population-based administrative data. BMC Public Health 12:301

    Article  PubMed Central  PubMed  Google Scholar 

  41. MacLean CH, Louie R, Leake B, McCaffrey DF, Paulus HE, Brook RH, Shekelle PG (2000) Quality of care for patients with rheumatoid arthritis. JAMA 284:984–992

    Article  CAS  PubMed  Google Scholar 

  42. Feldman DE, Bernatsky S, Haggerty J, Leffondre K, Tousignant P, Roy Y, Xiao Y, Zummer M, Abrahamowicz M (2007) Delay in consultation with specialists for persons with suspected new-onset rheumatoid arthritis: a population-based study. Arthritis Rheum 57:1419–1425

    Article  PubMed  Google Scholar 

  43. Lacaille D, Anis AH, Guh DP, Esdaile JM (2005) Gaps in care for rheumatoid arthritis: a population study. Arthritis Rheum 53:241–248

    Article  PubMed  Google Scholar 

  44. Public Health Agency of Canada (2013) The Canadian Chronic Disease Surveillance System. www.phac-aspc.gc.ca/surveillance-eng.php

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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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Correspondence to Jean-Pascal Roussy.

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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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