Dual-energy X-ray absorptiometry and anti-osteoporotic medication use in Australian patients with early rheumatoid arthritis using data from the Australian Rheumatology Association Database

Abstract

Background

People with rheumatoid arthritis (RA) are at increased risk of osteoporosis. The Australian Rheumatology Association RA Clinical Care Standard recommends fracture risk assessment at RA diagnosis and as clinically indicated.

Aims

The aim of this study was to evaluate the use of dual-energy X-ray absorptiometry (DEXA) for osteoporosis screening among Australian patients with early RA enrolled in the Australian Rheumatology Association Database (ARAD). We also aimed to assess the dispensing patterns of anti-osteoporotic medications in this population.

Methods

ARAD participants aged ≥18 years with a RA diagnosis from 2011 onwards and linked 2011–2023 Medicare Benefits Schedule and Pharmaceutical Benefits Scheme data were included (n = 306). Time to first DEXA and anti-osteoporotic medication dispensing was assessed using Kaplan–Meier failure functions and multivariable Cox regression. Covariates included age, sex, BMI, alcohol use, smoking and glucocorticoid use.

Results

The median time to first DEXA was 3 years (IQR 0, 10) following RA diagnosis. Predictors for DEXA included female sex (HR 1.6, 95% CI 1.1, 2.4), age ≥50 (HR 2.6, 95% CI 1.8, 3.9) and glucocorticoid use (HR 1.7, 95% CI 1.3, 2.4). DEXA was less likely with BMI ≥25 (HR 0.68, 95% CI 0.48, 0.96). By 8 years after RA diagnosis, 25% of participants received anti-osteoporotic medication, predicted by age ≥50 (HR 6.7, 95% CI 2.1, 21.4) and glucocorticoid use (HR 2.8, 95% CI 1.5, 5.0).

Conclusion

Our findings reveal delays and variability in osteoporosis screening for individuals with RA, despite higher fracture risk. Screening practices were influenced by age, glucocorticoid use and BMI, with significant gaps, particularly after diagnosis. These gaps highlight the need for standardised screening protocols to ensure timely DEXA scans and treatment, ultimately improving osteoporosis management and reducing fracture burden.