E012 An audit examining specialist referral for osteoporosis treatment for rheumatoid arthritis patients using new NOGG (National Osteoporosis Guideline Group) Guidelines 2022

Abstract

Abstract Background/Aims Major osteoporotic fractures remain an important cause of mortality and morbidity. Rheumatoid arthritis patients have significantly increased risk of fracture. New NOGG 2022 guidance recommends specialist referral for certain patients based on FRAX and other risk factors, to consider parenteral and anabolic treatment. Our aim was to assess how many rheumatoid arthritis patients would now require specialist referral. Methods We identified 38 patients with rheumatoid arthritis who had been referred for DEXA scanning in January 2022. FRAX was used to estimate fracture risk, this was then adjusted as per NOGG guidance to account for risk factors not included in FRAX. Intervention thresholds from new and old guidance were compared. Results 90% of patients were female. Average age was 63.2 years. Mean major osteoporotic fracture risk is 15.6 and mean hip fracture risk is 4.7 over 10 years. 31.6% had previous fracture, 8% had recent fracture, and 8% had vertebral fractures. 26.3% were taking steroids, 10.5% were taking high dose steroids. 5% had received parenteral treatment at time of audit. Conclusion Rheumatoid arthritis patients have an increased fracture risk and therefore require robust bone protection/fracture risk reduction. This is because of a combination of disease pathogenesis, and concurrence of fracture risk factors. Our cohort reflected this; fracture risk was high and risk factors, particularly steroid use, and previous fracture, were common. Under previous guidance, some patients would eventually be referred to a specialist at the discretion of their physician. New NOGG guidance recommends referral as first line for certain patients. When applied to this cohort, we can see that a significant number of patients would be referred to a specialist. This represents a significant shift away from oral therapies and towards consideration of specialist treatment. Under new guidance, a significant number of rheumatoid arthritis patients need specialist referral. This requires a substantial number of resources and means that parenteral therapies will have a much larger place in osteoporosis management. Disclosure A. Rauf: None. K. Moss: None.