Audit of the diagnosis, assessment, and treatment of osteoporosis in patients with ankylosing spondylitis.

OBJECTIVE

Osteoporosis (OP) is a well recognized complication of ankylosing spondylitis (AS), but there is no clear guidance to its appropriate management. To establish what might be considered as reasonable practice we surveyed the current practice of consultant rheumatologists in the United Kingdom.

METHODS

A questionnaire comprising 14 questions relating to the management of OP in AS was sent to 449 British rheumatologists. Three hundred ten (69%) of the 449 questionnaires sent were returned.

RESULTS

Only 98 respondents (31.6%) indicated that assessment of OP formed part of their routine management. Dual energy x-ray absorptiometry (DEXA) was the technique of choice for assessing bone mineral density (BMD) for 284 (91.6%). As general treatment, dietary advice was offered by 101 (32.6%) respondents, whereas 306 (98.7%) gave advice on exercise. Two case scenarios were presented and treatment choices recorded. When faced with a patient with osteopenia (-2.5 < T score < -1.0), 168 (54.2%) respondents would prescribe calcium and vitamin D supplements and 66 (21.3%) would prescribe a bisphosphonate. A second scenario featured a man with femoral neck T score of -2.80 and lumbar spine T score of -0.23. In this case 238 (76.8%) respondents would prescribe a bisphosphonate and 99 (31.9%) calcium and vitamin D, with some prescribing both. Thirty-eight (12.3%) would not prescribe calcium and vitamin D or a bisphosphonate. Two hundred twenty-seven (88.3%) rheumatologists indicated that they would repeat the BMD measurement in a patient with OP within 2 years.

CONCLUSION

The majority of British rheumatologists do not routinely assess patients with AS for OP. Most would manage OP in AS in a similar way to postmenopausal OP, but many would not. It does not appear to be generally recognized that in AS, spinal BMD as measured by DEXA rises with advancing radiographic changes, so that hip BMD is the measurement of choice. A robust evidence base is required to clarify guidelines for the management of OP in AS.