Because Dr. Yelin is Editor of Arthritis Care & Research, review of this article was handled by the Editor of Arthritis & Rheumatism.
Systemic Lupus Erythematosus
Osteoporosis screening, prevention, and treatment in systemic lupus erythematosus: application of the systemic lupus erythematosus quality indicators
Article first published online: 23 FEB 2010
Copyright © 2010 by the American College of Rheumatology
Arthritis Care & Research
Volume 62, Issue 7, pages 993–1001, July 2010
How to Cite
Schmajuk, G., Yelin, E., Chakravarty, E., Nelson, L. M., Panopolis, P. and Yazdany, J. (2010), Osteoporosis screening, prevention, and treatment in systemic lupus erythematosus: application of the systemic lupus erythematosus quality indicators. Arthritis Care Res, 62: 993–1001. doi: 10.1002/acr.20150
- Issue published online: 29 JUN 2010
- Article first published online: 23 FEB 2010
- Manuscript Accepted: 9 FEB 2010
- Manuscript Received: 6 NOV 2009
- American College of Rheumatology/Research and Education Foundation Physician-Scientist Development Award
- National Center for Research Resources. Grant Number: 5-M01-RR-00079
- Rosalind Russell Medical Research Center for Arthritis, NIH. Grant Number: R01-AR-44804
- State of California Lupus Fund
- Arthritis Foundation
- Agency for Healthcare Research and Quality
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. Grant Numbers: 1-R01-HS-013893, P60-AR-053308
Osteoporosis and fragility fractures are associated with significant morbidity for patients with systemic lupus erythematosus (SLE). New quality indicators (QIs) for SLE advise bone mineral density testing, calcium and vitamin D use, and antiresorptive or anabolic treatment for specific subgroups of patients receiving high-dose steroids.
Subjects were participants in the University of California, San Francisco Lupus Outcomes Study, an ongoing longitudinal study of patients with physician-confirmed SLE, in 2007–2008. Patients responded to an annual telephone survey and were queried regarding demographic, clinical, and other health care–related variables. Multiple logistic regression was used to predict receipt of care per the QIs described above.
One hundred twenty-seven patients met the criteria for the formal definitions of the denominators for QI I (screening) and QI II (calcium and vitamin D); 91 met the formal criteria for QI III (treatment). The proportions of patients receiving care consistent with the QIs were 74%, 58%, and 56% for QIs I, II, and III, respectively. In a sensitivity analysis of all steroid users (n = 427 for QI I and II and n = 224 for QI III), rates were slightly lower. Predictors of receiving care varied by QI and by denominator; however, female sex, older age, white race, and longer disease duration were associated with higher-quality care.
Bone health–related care in this community-based cohort of SLE patients is suboptimal. Quality improvement efforts should address osteoporosis prevention and care among all SLE patients, especially those receiving high-dose, prolonged steroids.