Management of Osteoporosis in Patients with Rheumatoid Arthritis: Insights from a Canadian Academic Division of Rheumatology
Notice bibliographique
Résumé
Objectives Despite compelling evidence for efficacy of osteoporosis (OP) treatment, fewer than 20% of patients experiencing a fragility fracture receive therapy in Canada. Given the links between rheumatoid arthritis (RA) and bone loss, we report the initial results of a quality improvement (QI) initiative at optimizing OP care as a comorbidity in RA patients in our rheumatology center. Methods This retrospective cross-sectional study primarily recruited RA patients aged 50+ from the observational Early Undifferentiated PolyArthritis (EUPA) cohort who had been followed by a rheumatologist for at least 1 year between January 2021 and December 2023. Outcomes were analyzed using the three-level Fracture Risk Assessment Tool (FRAX). Patients with bone metabolic disorders other than OP were excluded. Results Ninety-four patients were analyzed: 56 were female (59.6%), with a median age of 68.4 (IQR 62.9-76.2). Median disease duration was 84.4 months (IQR 47.5-120.4), and the median HAQ score at last follow-up was 0.125 (IQR 0-0.625). Erosive disease was present in 23 patients (24.5%), and 45 (47.9%) were seropositive. Nine (9.6%) were active smokers. Eleven patients (11.7%) had significant steroid exposure in the last year (prednisone 5mg daily for 3+ months or equivalent). At last follow-up, 45 patients (47.9%) were on vitamin D and 32 (34.0%) on calcium, and 25 (26.6%) had their 25-OH vitamin D levels checked in the last 2 years. In the last 5 years, 17 patients (18.1%) had a bone mineral density (BMD) whereas 6 (6.4%) had C-terminal telopeptide (CTX) serum levels measured. At last follow-up, using FRAX with BMD adjustment when available, 42 patients (44.7%) were high risk, 9 (9.6%) were medium risk, and 36 (38.3%) were low risk. Table 1 describes OP care data according to risk categories. Anti-resorptive medication was taken by 7 high-risk (16.7%), 3 medium-risk (33.3%), and 2 low-risk (5.6%) patients, with no statistical difference (p=0.064). Twelve patients (12.8%) had osteoporotic fractures: 10 were high-risk and 1 was medium risk (1 had missing data on FRAX). Six had major osteoporotic fractures: 4 occurred in the last 2 years, 3 of whom received anti-resorptive medication. Table 1. Osteoporosis care according to fracture risk categories Conclusion OP care for RA patients in our center is currently below Canadian standards, with a low proportion of high-risk fracture patients adequately managed. However, FRAX’s limitations include not considering fracture timing or RA activity in the evaluation. Initiatives are planned in the next steps of this QI project to raise rheumatologists’ awareness and enhance OP care in RA.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,004 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,002 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».