Awareness Campaign Increased DEXA Screenings for Osteoporosis
Doctors increased their use of DEXA screening and initiate osteoporosis therapy more frequently after the implementation of an initiative to raise their awareness of the 2017 American College of Rheumatology (ACR) guidelines for the management of glucocorticoid-induced osteoporosis (GIOP), according to researchers reporting at the annual meeting of the American College of Rheumatology on Friday.
Marielys Figueroa Sierra M.D.
Doctors increased their use of DEXA screening and initiate osteoporosis therapy more frequently after the implementation of an initiative to raise their awareness of the 2017 American College of Rheumatology (ACR) guidelines for the management of glucocorticoid-induced osteoporosis (GIOP), according to researchers reporting at the annual meeting of the American College of Rheumatology on Friday.
The 2017 ACR guidelines for the management of GIOP recommend baseline dual-energy x-ray absorptiometry (DEXA) scanning for patients initiated on glucocorticoid therapy at a dose of 2.5 mg or more per day for at least 90 days, and that scans are repeated every two to three years while patients remain on glucocorticoid treatment. To take account of GIOP-related fracture, the Fracture Risk Assessment Tool (FRAX) scores of patients on a daily dose of glucocorticoids of more than 7.5mg should be increased by 1.15 for major osteoporotic fractures and 1.2 for hip fractures, it adds. Osteoporosis treatment should then be offered to patients identified as moderate to high risk or on at least 30mg/day of glucocorticoid with a cumulative dose of more than 5g.
For this study Marielys Figueroa Sierra M.D., from the University of South Florida, Tampa, and colleagues attempted to raise awareness of the 2017 ACR guidelines among providers to increase screening for and treatment of osteoporosis at three outpatient specialty clinics affiliated with the University of South Florida (James A. Haley VA, Tampa General Hospital Health Park and USF Morsani).
A retrospective chart review of 2,665 patients attending the clinics between April 2018 and November 2019 identified 385 aged over 40 years who were prescribed at least 2.5mg glucocorticoids for 90 days of more – the pre-intervention group.
An intervention was then implemented, which aimed to educate providers about the ACR guidelines for the management of GIOP, along with the introduction of pre-visit chart reviews to identify patients at risk based on the guidelines.
Post-intervention, a retrospective chart review of 925 patients between November 2019 and April 2020 was performed which identified 230 patients that met the same inclusion criteria (aged over 40 years, prescribed at least 2.5mg glucocorticoids for 90 days of more) – the post-intervention group.
Patients in the pre- and post-intervention group had a similar average age, but there were more women in the pre-intervention group (55.6% vs 47.0% women, respectively). Rheumatoid arthritis was the most common disease in both groups, and prednisone was the most prescribed glucocorticoid with a third of patients receiving 5-10mg daily. Initiation of glucocorticoids was higher in pre-intervention group (177 vs 56, p< 0.001).
When performance against the ACR guidelines for the management of GIOP was assessed, the results revealed that DEXA screening increased from 56.9% of appropriate patients in the pre-intervention to 68.3% in the post-intervention group, with an absolute difference of 11.4% (p=0.005).While use of screening also increased for patients with specific conditions, most notably rheumatoid arthritis (from 56.9% to 61.3%) and vasculitis (from 58.7% to 73.0%), these increases were not statistically significant. However, screening did not increase for patients taking glucocorticoids at doses of 30mg or more day (48.3% vs 48.0%).
Following the intervention, prescription of appropriate osteoporosis treatment rose from 30.3% to 48.1% (p=0.002).
“Implementation of the 2017 ACR GIOP guidelines increased DEXA screening and osteoporosis therapy initiation in the post-intervention group by improving the identification of high-risk patients,” said Dr Figueroa Sierra. “Abiding by these guidelines will lead to a reduction in further osteoporosis complications.”
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REFERENCE
ABSTRACT: 0113. “Improving Glucocorticoid-Induced Osteoporosis Screening and Management in Patients with Rheumatic Diseases Using the 2017 ACR Guidelines.” The annual meeting of the American College of Rheumatology. 9:00 AM, Friday, Nov. 6, 2020.
