Andrea Lyon, Susan Lester, Jessica Stanhope, Tom Lynch, Rachel Black, Claire Barrett, Marissa Lassere, Rachelle Buchbinder, Lyn March, Oscar Russell, Catherine Hill
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We also aimed to assess the dispensing patterns of anti-osteoporotic medications in this population.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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 (<i>n</i> = 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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 7","pages":"1127-1135"},"PeriodicalIF":1.8000,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70065","citationCount":"0","resultStr":"{\"title\":\"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\",\"authors\":\"Andrea Lyon, Susan Lester, Jessica Stanhope, Tom Lynch, Rachel Black, Claire Barrett, Marissa Lassere, Rachelle Buchbinder, Lyn March, Oscar Russell, Catherine Hill\",\"doi\":\"10.1111/imj.70065\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>People with rheumatoid arthritis (RA) are at increased risk of osteoporosis. 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引用次数: 0
摘要
背景：类风湿性关节炎（RA）患者患骨质疏松症的风险增加。澳大利亚风湿病协会RA临床护理标准建议在RA诊断和临床指征时进行骨折风险评估。目的：本研究的目的是评估双能x线吸收仪（DEXA）在澳大利亚风湿病协会数据库（ARAD）中登记的澳大利亚早期RA患者骨质疏松症筛查中的应用。我们还旨在评估这一人群中抗骨质疏松药物的分配模式。方法：纳入2011年起年龄≥18岁诊断为RA的ARAD参与者以及相关的2011-2023年医疗保险福利计划和药品福利计划数据（n = 306）。使用Kaplan-Meier失效函数和多变量Cox回归评估首次DEXA和抗骨质疏松药物配药的时间。协变量包括年龄、性别、身体质量指数、饮酒、吸烟和糖皮质激素使用。结果：RA诊断后首次DEXA的中位时间为3年（IQR 0.10）。DEXA的预测因素包括女性（HR 1.6, 95% CI 1.1, 2.4）、年龄≥50 （HR 2.6, 95% CI 1.8, 3.9）和糖皮质激素使用（HR 1.7, 95% CI 1.3, 2.4）。BMI≥25的患者发生DEXA的可能性较小（HR 0.68, 95% CI 0.48, 0.96）。RA诊断后8年，25%的参与者接受抗骨质疏松药物治疗，预测年龄≥50岁（HR 6.7, 95% CI 2.1, 21.4）和糖皮质激素使用（HR 2.8, 95% CI 1.5, 5.0）。结论：我们的研究结果显示，尽管RA患者骨折风险较高，但骨质疏松症筛查的延迟和变异性。筛查实践受年龄、糖皮质激素使用和BMI的影响，特别是在诊断后存在显著差距。这些差距凸显了标准化筛查方案的必要性，以确保DEXA及时扫描和治疗，最终改善骨质疏松症的管理，减轻骨折负担。
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
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.
期刊介绍：
The Internal Medicine Journal is the official journal of the Adult Medicine Division of The Royal Australasian College of Physicians (RACP). Its purpose is to publish high-quality internationally competitive peer-reviewed original medical research, both laboratory and clinical, relating to the study and research of human disease. Papers will be considered from all areas of medical practice and science. The Journal also has a major role in continuing medical education and publishes review articles relevant to physician education.
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