Study Reveals Gaps in Glucocorticoid-Induced Osteoporosis Care Practices in People with Lupus
Investigators discovered several areas of needed clinical practice improvement for the prevention and treatment of glucocorticoid-induced osteoporosis (GIOP), a well-known complication where the bones become less dense and more likely to fracture, in people with lupus. Of those people with lupus who have GIOP, or are at risk, few are prescribed vitamin D and bisphosphonates (medications that prevent the loss of bone density). In others, bisphosphonates are prescribed, despite not meeting American College of Rheumatology (ACR) guidelines, resulting in overtreatment.
The charts of 654 people with lupus were analyzed, and 203 people were identified as high-risk for glucocorticoid (GC) use. The recommended dose of vitamin D was prescribed in 58.9% of people less than 40 years old and 61.5% of those over 40 years. Nearly a quarter (23.3%) of younger persons with lupus and 13.8% of older persons had no record of any vitamin D supplementation. For those older than 40 years of age, bisphosphonate therapy was indicated for 47 (36.2%) people, but only 19 (14.6%) were prescribed one. Another 13 (10.0%) people were prescribed a bisphosphonate, despite not having an indication per the ACR guidelines and considered overtreatment. The researchers also identified patient characteristics associated with bisphosphonate prescribing, including older age and higher Fracture Risk Assessment (FRAX) scores for both major osteoporotic (OP), or porous bone, and hip fracture.
GC therapy is frequently used for the treatment of disease flares and complications in lupus, yet a major concern of long-term GC therapy is increased risk for GIOP. For prevention of GIOP, ACR recommends all people with lupus receiving continued GC treatment, also receive calcium and vitamin D supplementation. Bisphosphonate therapy is also recommended for those receiving high-dose GC treatment.
The prevention and treatment of GIOP among people with lupus is important. To bring care up to the 2017 ACR recommendations, vitamin D supplements and bisphosphonates should be prescribed more often to appropriate candidates and not prescribed to people with lupus who do not meet appropriate criteria. This study emphasizes the importance of being vigilant about who meets the criteria for bisphosphonates and who does not. People with lupus should speak with their physician often about best care possible. Learn more about how lupus affects the bones.