AB1084-HPR Light-Minded Follow up of Osteoporosis Prophylaxis at Nurse Consultations in Glucocorticoid Treated Polymyalgia Rheumatica Leads To Higher Compliance
Authors: S.H. Jakobsen, A. Emamifar, I.M.J. Hansen
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> Compliance to osteoporosis prophylaxis in postmenopausal women is described to be very poor [1]. The compliance to prophylactic osteoporosis medication in patients with inflammatory diseases treated with Glucocorticoids (GC) is higher [2], probably due to the risk of osteoporotic fractures as a side effect of GC treatment [3]. <h3>Objectives</h3> To evaluate the adherence to osteoporosis prophylaxis in a group of patients suffering from polymyalgia rheumatica (PMR) treated with GC. <h3>Methods</h3> At our department patients with milder disease are seen at every second consultations by a nurse specialized in rheumatology. At all nurse consultations the patients are asked, in a friendly and understanding manner, if they remember to take the prescribed calcium and vitamin D, as well as the name of the medication and where they buy it. If Bisphosphonate is prescribed they will be questioned about this as well. The nurses also check the date of dual-energy x-ray absorptiometry (DEXA) scans. In this cross sectional study, all patients (138) diagnosed with PMR within 2013 were interviewed about their compliance toward osteoporosis prophylaxis using a standardized questionnaire. <h3>Results</h3> 138 patients were identified, 20 patients were excluded (diagnoses were changes (12), did not want to participate (2), unreachable (3), found dementia (3)). A total of 118 patients were included. Of these 117 were prescribed calcium and vitamin D. 88.9% of these took the medication as prescribed. The reasons for the non-compliance were given as: "Forgetfulness, did not want to eat so many pills and side-effects". Bisphosphonate was prescribed in patients (61) when the results of DEXA scan gave a T-score of less than -1. Of these patients 96.6% took the medication on a regular basis. Noncompliance to Bisphosphonate was in all cases due to gastrointestinal side effects. <h3>Conclusions</h3> Our results illustrate that it is possible to increase compliance considerably if the nurses at every consultation ask about the prophylactic medications, at least in this group of patients with a very painful disease. Furthermore we think that the friendly atmosphere, in which questions are given and the dialogue about the importance of the medication to avoid side effects of GC such as fractures, is very important. Our results should be confirmed in a randomized clinical trial, to rule out information bias. <h3>References</h3> Castelo-Branco C, Cortés X, Ferrer M; UNICAD study investigators. Treatment persistence and compliance with a combination of calcium and vitamin D. Climacteric. 2010;13:578–84. Emamifar A, Gildberg-Mortensen R, Andreas Just S, Lomborg N, Asmussen Andreasen R, Jensen Hansen IM. Level of Adherence to Prophylactic Osteoporosis Medication amongst Patients with Polymyalgia Rheumatica and Giant Cell Arteritis: A Cross-Sectional Study. Int J Rheumatol. 2015;2015:783709. Duru N, van der Goes MC, Jacobs JW, et al. EULAR evidence-based and consensus-based recommendations on the management of medium to high-dose glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis. 2013;72:1905–13. <h3>Disclosure of Interest</h3> None declared