Prevalence of fragility fractures and prescribing of medications for osteoporosis in patients with polymyalgia rheumatica (PMR): Results from the PMR Cohort Study

The Problem:

Polymyalgia rheumatica (PMR) is one of the commonest indications for long term

glucocorticoid (GC) treatment, which can lead to an increased risk of osteoporosis and subsequent fragility fractures.  Guidelines recommend calcium and vitamin D supplements and anti-resorptive agents as treatment. The association between medication for osteoporosis and fracture experience in patients with PMR has not previously been examined.

Your Approach:

652 people with an incident diagnosis of PMR responded to a baseline survey. This cohort gave information on their general health, sociodemographic characteristics and their experience of PMR. Participants completed further questionnaires at 1, 4, 8, 12, 18 and 24 months. Data on fractures and the prescriptions were collected at 12 and 24 months. For this work, fragility fractures were defined as fractures of the hip, wrist or spine. Logistic regression models were used to assess the association between baseline characteristics and fractures at 12 and 24 months. Analysis was conducted unadjusted and adjusted for age, gender, reported medication use and falls history.

The Learning:

Fewer than 50% of respondents were ever prescribed treatment for osteoporosis. Being prescribed treatment for osteoporosis was associated with a reduced incidence of fragility fractures at 24 months (adjusted OR 0.28 95% CI 0.10-0.80), but an increased incidence at 12 months (adjusted OR 2.10 95% CI (1.3-3.48). Falls before baseline was the factor most strongly associated with fragility fracture at 12 (OR 2.35 95% CI 1.35-4.12) and 24 months (OR 1.91 95% CI 1.05-3.49) when unadjusted for previous fractures. Calcium and vitamin D prescription, gender and age were not significantly associated with fracture outcome.

Why It Matters:

More needs to be done to encourage adherence to prescribing guidelines. Further studies need to address reasons for non-adherence to guidelines and the effects of long-term GC treatment for PMR.

Presenting Author:

Balamrit Singh Sokhal, Keele University, w9b69@students.keele.ac.uk

Co-authors:

Samantha L Hider1,2, s.hider@keele.ac.uk

Zoe Paskins1,2 z.paskins@keele.ac.uk

Christian D Mallen1, c.d.mallen@keele.ac.uk

Sara Muller1  s.muller@keele.ac.uk

1. Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK
2. Haywood Academic Rheumatology Centre, Midland Partnership NHS Foundation Trust, Stoke-on-Trent, ST6 7AG, UK