Getting to the bones of it: A clinical audit of osteoporosis management in an Australian SLE Cohort.

Background/purpose: Systemic Lupus Erythematosus (SLE) patients are at increased risk of osteoporosis, due to disease-related and traditional risk factors including common use of glucocorticoids (GC). Bone mineral density (BMD) screening is important for overall fracture risk assessment; in Australia, it is reimbursed under the Medicare Benefits Schedule (MBS) for specific criteria. Objective(s): To evaluate compliance with BMD testing according to MBS reimbursement schedule. Method(s): Data on BMD testing and patient characteristics where obtained from the Australian Lupus Registry. Descriptive statistics were used to evaluate patient characteristics at the time of BMD testing. Result(s): Patients with at least 2 annual visits and seen in the last 5 years were included in the analysis (n = 263); 154 (58.6%) had at least one BMD. Most (90.3%) had taken GC at some point. The mean age at the time of undergoing the first test was 42 years. Of the patients tested, 15.6% were identified as having osteoporosis (t score <=-2.5) and 46.1% were osteopenic (t score <-1). Of 273 BMD performed, at least one of the MBS reimbursement criteria (see Table 1) was present for 59.7% of tests. In those did not fulfil criteria, 39% had at least osteopenia or osteoporosis. In 63.6% of cases, the patient had met the cumulative prednisolone exposure definition but was not on GC at the time of the test. Of the 154 patients who had BMD testing, 46.7% had repeated measurements. Compliance with testing frequency was met for 74.8% of repeat tests. Conclusion(s): The majority of patients who had BMD testing had risk factors for osteoporosis. Our audit shows that a significant proportion of patients with previous GC exposure would have been missed the strict criteria of MBS reimbursement. Since the value for repeated BMD testing is controversial, further studies should explore their utility in this population.