Category: Osteoporosis

OSTEOPOROS

Over the last two decades, the ability to diagnose and treat osteoporosis has dramatically improved. The advances in treatment of osteoporosis have unfortunately been underutilized in non-caucasian populations. Researchers have highlighted that the current guidelines for screening and treatment are primarily based on data obtained from studies of postmenopausal Caucasian women, as insufficient data is available in African-American women. This study provides data regarding the frequency of decreased BMD in African-American women.

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Preventive Medicine and Screening

The demographics of the patients included in the chart review are shown in Table 1. The mean age of the group was 69.6 years (range 53-94). Of the 252 women, only 11.5% had documentation of prior central bone densitometry (DEXA). Nearly 39% of the women were counseled about calcium and/or vitamin-D intake. Recommendations for hormone replacement therapy were documented for 54% of the women. In this same population, 74% of women had recently undergone screening mammography. The difference in the rates of screening for osteoporosis and statistically significant (p<0.001). There was no difference in the rates of DEXA or mammography between blacks and whites in this group (data not shown). For the African-American women, screening mammography was performed significantly more often than bone densitometry across all different age groups (Table 2).

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Setting

This study was completed in the Medicine Clinic at Barnes-Jewish Hospital at the Washington University Medical Center in St. Louis, MO. Approximately 160 internal medicine residents see patients in this urban clinic, which had over 31,000 patient visits in 2000. The clinic serves primarily middle-aged and elderly adults from minority ethnic groups. In 2000, 65% of patient encounters were with adults over the age of 50, including 42% of encounters with adults over 65. Approximately 75-80% of patients seen at this clinic are African American, and 88% have Medicaid, Medicare, or both as their primary form of medical insurance.

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OSTEOPOROSIS

INTRODUCTION

is a metabolic bone disorder that affects more than 25 million Americans. Osteoporosis is characterized by low bone mass, which makes bones fragile and susceptible to fractures.

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Prevalence of Osteoporosis and Osteopenia DISCUSSION

To our knowledge, this is the first study to examine the prevalence of low bone density in African-American patients with RA (including patients with either early or established disease). Depending on the race/ethnicity of the reference population used, we found that approximately one-third to half of patients were osteopenic or worse, and 5-16% were osteoporotic with <2 years of disease duration.

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Patient Characteristics

Characteristics of the 175 study participants are summarized in Table 2. Study participants had a mean age of 51 ± 13 years and were predominantly women (n=144, 82%). Patients had a mean RA disease duration of 14 ± 7 months and a substantial majority of participants (n=145, 83%) had received prior treatment with oral glucocorticoids (mean self-reported prednisone dose = 9.4 ± 9.2 mg/d). Patients had a mean body mass index of 31.3 ± 7.1 kg/m2 and approximately one-half of patients (n=99, 57%) were either current or past cigarette smokers. Many were receiving either calcium (n=82,47%) or vitamin D supplements (n=26, 15%) at the time of DXA measurement, but only a small minority had ever used prescription bisphospho-nate treatments (n=6, 3%). Overall, patients had moderate-to-severe disease activity as evidenced by mean tender and swollen joints counts in addition to mean disability index scores (Table 2).

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Patients

Participants were enrollees in the Consortium for the Longitudinal Evaluation of African Americans with Early Rheumatoid Arthritis (CLEAR). Eligible participants self-reported African-American ethnicity, had an established diagnosis of RA as defined by the American College of Rheumatology (ACR) classification criteria and had <2 years of disease duration (from time of symptom onset). All patients underwent a comprehensive physical examination and were asked to provide a detailed medical history. RA disease activity was quantified by a board-certified rheumatologist using tender and swollen joint counts in addition to self-reported disability index scores (measured using the Stanford Health Assessment Questionnaire).

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