AUDIT ON SCREENING, MANAGEMENT AND FOLLOW UP OF LOW BONE DENSITY IN PATIENTS WITH INFLAMMATORY ARTHRITIS
Aaisha Khan, Ella Shanahan, Oliver Fitzgerald
St Vincent’s University Hospital, Elm Park, Dublin, Ireland
Guidelines are lacking on the screening and management of low bone mineral density (BMD) in patients with inflammatory arthritis (IA), who are at high risk of compromised BMD because of the disease, steroid usage and other risk factors. There is also individual variability regarding follow up imaging.
To audit the screening and management of low BMD in IA within a Rheumatology Rehabilitation Unit.
Patients admitted from 14th Aug to 31st Dec 2017 were enrolled in the audit after informed consent. Parameters analysed included screening for low BMD since diagnosis, appropriateness of medications, education on lifestyle and exercises, repeat DEXA interval and the type of scanner. Data was collected by review of medical record, face-to-face and telephonic interviews. It was analysed with SPSS.
A total of 50 (45 females, 5 males) patients were included. 11 patients had no DEXA planned since diagnosis and 1 was awaiting. 18 patients did not have FRAX screening. 8 patients had DEXA within 2 years of diagnosis. Out of those who had the DEXA, 5 never had a repeat scan and only in 15, it was repeated within 5 years. 20 had the DEXA scan on the same machine. 5 patients had osteoporosis on scan out of which 4 were on bone protection. 19 patients had osteopenia out of which 18 were on calcium and vit D supplementation. 34 out of 50 stated they did not receive education on bone health and DEXA scanning during admission. 18/50 did not receive life style advice and 3/50 were unfamiliar with weight bearing excerices.
Timely and regular assessment of fracture risk is essential in patients with IA . Our audit indicates that there is lack of clarity on best practice in the timing of assesment of bone density after diagnosis and subsequent follow up. It also showed that majority of those with low bone density were on the appropriate bone protection. Follow up DEXA was performed on the same machine for all the patients. There should be more focus on educating patients about the screening process and its significance.