Suboptimal prescribing of osteoporosis medications in people with polymyalgia rheumatica
medwireNews: Less than half of patients with polymyalgia rheumatica (PMR) are prescribed medications for osteoporosis, despite clinical guidelines recommending bone protection for those on long-term glucocorticoid treatment, research suggests.
Presenting the findings at the online British Society for Rheumatology (BSR) 2021 Annual Conference, Balamrit Singh Sokhal (Keele University, Newcastle Under-Lyme, UK) said that although PMR treatment guidelines recommend high-dose glucocorticoids followed by a tapering regimen over 2 years, “evidence shows that in the majority of cases, treatment for PMR goes beyond 2 years,” leading to an increased risk for osteoporosis.
“Therefore, patients with PMR who are taking glucocorticoids have an increased risk of fragility fractures,” he added, noting that the BSR guidelines recommend co-prescription of bone protection medication to reduce this risk.
Sokhal and colleagues’ survey-based study included 652 patients with PMR, 97.0% of whom were treated with prednisolone at baseline. However, just 46.6% of participants reported being prescribed calcium and vitamin D at baseline, while only 4.5% of those aged less than 65 years and 21.6% of those aged 65 years or older were prescribed medications such as bisphosphonates, hormone replacement therapy, or strontium. Overall, less than 50.0% of respondents had ever been prescribed a treatment for osteoporosis.
A total of 112 respondents reported a previous fragility fracture at baseline, while 72 experienced a fragility fracture during the first year of follow-up, as did 62 during the second year. The majority of patients with fragility fractures at 1 and 2 years also reported fragility fractures at baseline, at rates of 83.3% and 79.0%, respectively.
“This analysis highlighted that fractures remain a very important problem, that prescribing of medication remains suboptimal despite guidelines to support prescribing, [and that] this was suboptimal even in patients who had a history of previous fracture,” said Sokhal.
He noted that falls prior to baseline “were the strongest predictor of future fragility fractures” at the 1- and 2-year follow-ups, with odds ratios of 2.35 and 1.91, respectively. In all, 37.5% of patients with fractures during the first year and 35.5% of those with fractures during the second year had previously experienced falls.
“Given the impact of PMR on pain and stiffness, it may be that people with PMR are at an increased risk of falls, and currently falls are not featured prominently in PMR guidelines,” commented Sokhal.
“It may be that in addition to treatments for osteoporosis, clinicians should consider taking a history of falls,” he added.
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group