098. BISPHOSPHONATE USE AND MONITORING IN A GENERAL RHEUMATOLOGY CLINIC

Abstract

Background: Use of bisphosphonates is widespread in patients attending rheumatology outpatient departments, both for primary osteoporosis and for prevention and treatment of glucocorticoidinduced osteoporosis (GIO). With recent awareness of the need for regular monitoring of patients taking bisphosphonates and the potential risks from long-term use, we examined the indications, duration and monitoring of bisphosphonate (bp) use in the routine rheumatology outpatient setting. Methods: We examined the records of 470 consecutive review patients attending the rheumatology outpatient department in the Western Health and Social Care Trust (WHSCT) in Northern Ireland. None of these patients was under review purely for osteoporosis (these patients being seen at other clinics) as we wished to focus on the general rheumatology population. Results: 470 consecutive patient records were examined (270 female and 200 male). 62 (13.4%) were prescribed weekly or monthly oral bisphosphonate and 2 six monthly denosumab s/c. Those taking bisphosphonates were significantly older than the group as a whole, (median age 70.5 v 54.8, p<0.01) and more were female [46/63 (73%) v 270/470 (57%), p=0.18]. Of the 62 patients using bisphosphonates, 38 were currently taking oral prednisolone (63%), 14 (23%) of whom were taking the steroid for polymyalgia rheumatica. Length of time on bisphosphonates ranged from less than 1 year to more than 12 years. Median duration was 3.0 yrs, with 72% of patients on the drug for less than 5 years, 25% between 5 and 9 years and 3% 10 years or over. 27% of patients taking bp had never undergone a DEXA scan. Of the 73% who had, the median duration of bp use was 2.5 years, as compared with 4.5 years in those who had not. 88% of patients who had never undergone a DEXA scan were prescribed steroid, and the other 12% had been prescribed steroid in the past when the bp was commenced. All PMR patients currently prescribed bp were long term oral steroid users, as compared with less than half of patients with an inflammatory arthritis. Conclusion: Around 13% of unselected rheumatology review patients take regular oral bisphosphonates, and 64% of this group were taking oral corticosteroid. Around a quarter of bp users have never had a DEXA scan. There is a potential gap in monitoring of bp patients who start the drug while prescribed steroids without a DXA and continue it in the longer term without further monitoring, even after the steroid has been withdrawn.