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Objectives To evaluate the prevalence of self-perceived depression and anxiety in patients with systemic lupus erythematosus (SLE) and to explore associated factors. Methods Cross-sectional study of unselected patients with SLE (ACR-97 criteria) and controls with chronic inflammatory rheumatic diseases. Both completed the Hospital Anxiety and Depression Scale (HADS). Demographic and clinical characteristics, comorbidity, and treatments were collected, and a multivariate analysis was performed to explore factors associated with depression and anxiety in SLE. Results The study population comprised 172 patients and 215 controls. Women accounted for 93% of the patients with SLE. Fibromyalgia was recorded in 12.8% and a history of depression in 17%. According to HADS, 37.2% fulfilled the diagnostic criteria for depression and 58.7% those for anxiety; prevalence was similar in the controls (32.6% and 55.1%, respectively). Up to a third of patients with self-perceived depression were not receiving antidepressants. There was no concordance between a previous history of depression and current depression. In the multivariate model, current depression was associated with single marital status (OR 2.69; 95% CI: 1.17–6.42; p = .022), fibromyalgia (7.69; 2.35–30.72; p = .001), smoking (3.12; 1.24–8.07; p = .016), severity of SLE (0.76; 0.6–0.94; p = .016), and organ damage (1.27; 1.01–1.61; p = .042). Current anxiety was only associated with fibromyalgia (3.97; 1.21–17.98; p = .036). Conclusions Depression and anxiety are most likely underdiagnosed in SLE. Prevalence appears to be similar to that of other chronic inflammatory rheumatic diseases. Anxiety is associated with fibromyalgia, while depression is also associated with single marital status, smoking, organ damage, and severity of SLE.

To estimate the incidence of clinical fragility fractures in postmenopausal women with rheumatoid arthritis (RA) and analyze risk factors for fracture.Incidence of clinical fragility fractures in 330 postmenopausal women with RA was compared to that of a control population of 660 age-matched postmenopausal Spanish women. Clinical fractures during the previous five years were recorded. We analyzed associations with risk factors for fracture in both populations and with disease-related variables in RA patients.Median age of RA patients was 64 years; median RA duration was eight years. Sixty-nine percent were in remission or on low activity. Eighty-five percent had received glucocorticoids (GCs); 85 %, methotrexate; and 40 %, ≥1 biologic DMARD. Fifty-four patients and 47 controls had ≥1 major osteoporotic fracture (MOF). Incidence of MOFs was 3.55 per 100 patient-year in patients and 0.72 in controls (HR: 2.6). Risk factors for MOFs in RA patients were age, previous fracture, parental hip fracture, years since menopause, BMD, erosions, disease activity and disability, and cumulative dose of GCs. Previous fracture in RA patients was a strong risk for MOFs (HR: 10.37).Of every 100 postmenopausal Spanish women with RA, 3-4 have a MOF per year. This is more than double that of the general population. A previous fracture poses a high risk for a new fracture. Other classic risk factors for fracture, RA disease activity and disability, and the cumulative dose of GCs are associated with fracture development.

Fracture Liaison Service (FLS) model for secondary prevention of fractures has demonstrated its cost-effectiveness using decision models. We analyze the impact of a FLS on pharmaceutical expenditures for osteoporosis (OP) in real-world circumstances.Expenditures on OP medications from January 2011 to January 2017 were compiled. Pharmaceutical expenditures in the southern area of Gran Canaria were used as a control group to measure the impact of implementing an FLS in the northern area. We estimated generalized least squares regressions with interrupted time-series analysis where two interventions were considered: March 2012 (implementation of the FLS) and March 2016 (incorporation of nursing staff for inpatients with hip fracture).The northern area incurred greater expenditures for group I and II drugs. The difference in bisphosphonates expenditures between areas varied from 10.5% higher in the northern area pre-FLS to 11.2% post-FLS and 18.3% since March 2016. However, interrupted time series models do not find a significant impact of implementation of FLS on the pharmaceutical expenditures for either drug group.The implantation of an FLS did not lead to an increase in pharmaceutical expenditures for OP over the 5-year period compared to the standard care provided for secondary fracture preventions.

A fracture liaison service in Spain is able to maintain 73 % of the patients on antiresorptive 2 years after the fracture. The purpose of this study was to evaluate the 2-year effectiveness of a program for the secondary prevention of fractures. Fragility fractures in patients over 50 attending the emergency room in our centre are captured by the recruitment system of a secondary prevention program. The unit is attended by a nurse, coordinated by two rheumatologists and with the collaboration of primary care consisted of a training program and annual meetings. The outcome of the program was analysed 2 years after implementation, including: (1) percentage of attendees/eligible; (2) percentage of attendees who start treatment with antiresorptive; (3) percentage of patients who retain treatment after 6, 12, 18 and 24 months; and (4) factors associated to adherence. After 2 years of implementation, the program detected 1674 patients with fracture, of whom 759 finally entered the program (57 % of eligible). After 3 months, 82 % of patients prescribed an antiresorptive started treatment. After a year, 52 % of the patients in the program, 72 % of those of a prescribed treatment, were taking antiresorptives. Adherence at 24 months among those who had prescribed anti-fracture drugs was 73 %. Factors associated with adherence at 12 months were female sex (76 vs 45 %; p = 0.01) and previous treatment with antiresorptive (86 vs 68 %; p = 0.02). In Spain, a program designed to prevent secondary fragility fractures based on the collaboration between primary care and rheumatology seems effective in terms of recruitment of patients and adherence to treatment in the mid/long-term.

Resumen Objetivo Evaluar la influencia de la implantacion de un programa para la prevencion secundaria de fracturas osteoporoticas sobre la prescripcion de bisfosfonatos y la persistencia del tratamiento a corto plazo. Pacientes y metodos Se incluyeron pacientes con fractura por fragilidad > 50 anos atendidos en el servicio de urgencias durante un ano. El programa consistio en: 1) plan de formacion en osteoporosis de los medicos de primaria; 2) densitometria osea; 3) cuestionario relativo a osteoporosis y educacion del paciente por la enfermera; 4) derivacion al medico de primaria o, en caso de multiples fracturas o precisar terapia parenteral, a consulta hospitalaria; y 5) seguimiento y comprobacion de inicio del tratamiento prescrito a traves de los registros electronicos y encuesta telefonica. La variable principal de desenlace fue el porcentaje de pacientes que, habiendose prescrito un bisfosfonato, cumple el tratamiento a los 3 meses. Resultados De 532 pacientes con criterios de inclusion, 202 (38%) no aceptaron participar. Comparados con los pacientes que participaron, los que rechazaron tenian una edad promedio mayor (p Conclusiones El programa de prevencion secundaria de fracturas coordinado por reumatologia consigue que el numero de pacientes que inicia bisfosfonato se multiplique por 4 en comparacion con la visita basal.

The aim of this study was to analyze the longitudinal practice patterns of prophylaxis of glucocorticoid-induced osteoporosis in patients with polymyalgia rheumatica (PMR). Patients diagnosed with PMR were collected retrospectively in two rheumatology departments. In addition to demographic and diagnostic criteria, the chart review included the following information at baseline and at follow-up: doses of prednisone, prescription of calcium, vitamin D and bisphosphonates, bone mass measurement (BMD) and fragility fractures. We analyzed the percentage of patients undergoing BMD and were prescribed a bisphosphonate over the years. We evaluated 158 patients: 117 of them were women, mean age was 73 years, and they had an average follow-up of 4.8 years. 104 patients (66 %) received osteoporosis medication during the first visit, 44 of them were given bisphosphonate. During follow-up, another 30 treatments with bisphosphonate were added (46 % overall) while 37 cases (23 %) received no treatment with calcium or bisphosphonate. BMD was performed in 111 patients (69 %; 53 % of males and 76 % of females). Factors associated with the use of bisphosphonates were female sex (OR 4.4, 95 % CI 4.02-4.86), BMD (OR 2.4, 95 % CI 2.05-2.78) and commencement of treatment after the year 2005 (54 vs 37 %, OR 1.93, 95 % CI 1.60-2.26). No significant differences were found with age, initial doses of prednisone or the hospital. According to recent prevention guidelines, treatment with biphosphonate should have been administered in more than 90 % of patients. Although prophylaxis of glucocorticoid-induced osteoporosis in patients with PMR has increased in the recent years, many patients do not receive prophylaxis with bisphosphonate during the first visit.

Resumen Fundamento y objetivo Existen distintas guias para la prevencion secundaria de fracturas relacionadas con la osteoporosis. El objetivo de este estudio fue analizar su aplicacion en una cohorte de pacientes con fractura por fragilidad. Pacientes y metodo Los adultos mayores de 50 anos registrados en el servicio de urgencias del hospital con fractura por fragilidad fueron invitados a un estudio de prevencion secundaria de fractura. Se recogieron los datos clinicos incluidos en el indice FRAX y se realizo densitometria osea. Para el calculo de los pacientes candidatos a prevencion se emplearon las guias de manejo de la osteoporosis. Resultados Aplicando las guias de prevencion a 380 pacientes incluidos, el porcentaje de candidatos a tratamiento fue del 54-100% en las mujeres y del 26-81% en los varones. En las fracturas de cadera la cifra fue del 81 al 100% y en las de antebrazo del 36 al 93%. El riesgo de fractura de cadera por el indice FRAX fue ≥3% en el 35% de la muestra. Las guias mas restrictivas fueron la National Institute for Health and Clinical Excellence y la National Osteoporosis Foundation 2009 (54-57%), a diferencia de la National Guideline Clearinghouse y la National Osteoporosis Guideline Group (87-93%). Conclusiones Existen diferencias en el porcentaje de pacientes a tratar para prevenir nuevas fracturas segun la guia de tratamiento aplicada. La inclusion del FRAX conlleva una reduccion de casos a tratar.

a b s t r a c t Objective: To assess the influence of the implementation of a program for secondary prevention of osteoporotic fractures on prescribing bisphosphonates and persistent short-term treatment. Patients and methods: Patients >50 years of age with fragility fracture attended in the emergency depart- ment were enrolled in an observational study. The program consisted of (1) training of primary care physicians, (2) baseline visit: questionnaire on osteoporosis, bone densitometry and patient education, (3) patient referral to primary care, except those with multiple fractures or requiring special study or therapy, who were referred to a specialist, and (4) follow-up by checking prescriptions in electronic records, and a telephone survey. The outcome variable was the percentage of patients who, on having been prescribed bisphosphonates, still adhered to the treatment at 3 months. Results: Of the 532 patients with inclusion criteria, 202 (39%) refused to participate. Those who refused to take part had a higher mean age (P

Our purpose was to assess the impact of a secondary prevention program for osteoporotic fractures in patients with fragility fracture and to determine its effect on long-term compliance with bisphosphonate treatment. Persistence with bisphosphonate use was 71%. Attending follow-up visits was the only variable significantly associated with adherence to bisphosphonates. The aim of this study is to assess the impact a secondary prevention program for osteoporotic fractures in a prospective cohort of patients with at least one fragility fracture and to determine the effect of this intervention on long-term compliance with bisphosphonate treatment. All patients older than 50 years with a fragility fracture attended at the emergency department over a 2-year period were appointed for a clinical visit through a telephone call. Two follow-up controls at 4 and 12 months were scheduled. After a mean of 4 years, a telephone survey was conducted to assess compliance with treatment. Of 683 eligible patients, 380 (55.6%) were visited at the hospital. Previous treatment with bisphosphonates was recorded in 17.9% of patients. DXA scan was considered normal in 61 patients and revealed osteopenia in 184 and osteoporosis in 135. Pharmacological treatment was indicated in 90% of patients (alendronate in 76%). Among 241 patients who participated in the survey, eight patients had new fractures (four were on treatment with bisphosphonates and four had discontinued treatment). Of 187 patients in which bisphosphonates were prescribed at the initial visit, 133 (71.1%) continued using bisphosphonates. Attendance of scheduled visits was associated with adherence to bisphosphonates (odds ratio, 3.33; 95% confidence interval, 2.99–3.67). The efficacy of the program to recruit patients was 55%. In patients visited at the hospital, treatment with bisphosphonates increased from 17.9% to 76%. Persistence with bisphosphonate use after a mean of 4 years was 71%. Attending follow-up visits was significantly associated with adherence to bisphosphonates.

There are different guidelines for secondary prevention of fractures related with osteoporosis. Our aim is to analyse the appliance of such guidelines in a sample of patients with fragility fractureAdult patients older than 50 years attended in the emergency department with a fragility fracture were invited to participate in a study for secondary prevention. Clinical data and densitometry for the FRAX index were recorded. Current guidelines were employed to calculate the number of patients who needed secondary prevention.With the appliance of current guidelines to 380 patients, 54-100% of women and 26-81% of men were candidates for treatment. For hip fractures the percentage was 81-100% and for forearm fractures 36-93%. FRAX index for hip fracture was ≥3% in 35% of patients. The National Institute for Health and Clinical Excellence and the National Osteoporosis Foundation 2009 were the most restrictive guidelines (54% and 57% respectively). On the other hand the National Guideline Clearinghouse (87%) and the National Osteoporosis Guideline Group (93%).There are high differences in the percentage of patients who need treatment to prevent new fractures according to the guidelines. Fewer patients require treatment when the FRAX index is included in a guideline.

Background Although management of osteoporosis (OP) is cost-effective in high-risk patients, less than 20% of patients with fragility fracture receive antiresorptive drugs and more than 50% stop treatment after a year. Objectives The main objective was to evaluate the long-term adherence to treatment of a program for secondary prevention of OP fractures Methods Patients >50 years with fragility fracture were enrolled in a prospective observational study. The program consisted of: 1) training of primary care physicians, 2) recruitment of patients from emergency unit, 3) baseline visit: questionnaire by the nurse, bone densitometry and patient education; 4) clinical report referral to primary care or rheumatology (those with multiple fractures or requiring special therapy); and 5) follow-up through a phone survey and checking the prescriptions in electronic records. The outcome of the program was analysed 2 years after implementation, including 1) percentage of attendees/eligible; 2) percentage of attendees who start treatment with bisphosphonates; 3) percentage of patients who retain treatment after 6, 12,18 and 24 months; and 4) factors associated to adherence. Results After 2 years of implementation, the program detected 1674 patients, of whom 759 finally entered the program (57% of eligible). After 3 months, 52% of the patients (82% of those with prescribed antiresorptive) in the program started treatment. Factors associated with starting treatment at 3 months were female sex (85% vs 71%; p=0.01), previous treatment with antiresorptive (91% vs 80%; p=0.02), hip fracture (89% vs forearm 75%; p=0.007) and being attended by a rheumatologist (89% vs primary care 69%; p The causes of withdrawal of treatment at 12 months in 83 phoned patients were as follows: 25 patients do not agree to take treatment, 24 patients by unknown reasons, 18 stopped or not started by primary care doctor, 8 because gastrointestinal complaints, 5 because of being taking many drugs, and 3 because others diseases. Conclusions In Spain, a program designed to prevent secondary fragility fractures based on the collaboration between primary care and rheumatology is effective in terms of recruitment of patients and adherence to treatment in the long-term. Acknowledgements Proyecto nacional del Ministerio de Ciencia e Innovaciόn. Instituto de Salud Carlos III: PI11/01429 Disclosure of Interest None declared