Management of Osteoporosis in Patients with Rheumatoid Arthritis: Insights from a Canadian Academic Division of Rheumatology
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.004 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".