Predictors of fragility fracture and low bone mineral density in patients with a history of parental fracture

Abstract Background/Aims Osteoporosis (OP) is an extra-articular manifestation of rheumatoid arthritis (RA) that leads to increased fracture susceptibility due to a variety of reasons including immobility and cytokine driven bone loss. Bone loss in other populations has well documented risk factors. It is unknown whether bone loss in RA predominantly affects the femoral neck or the spine. This study aimed to identify independent predictors of low bone mineral density (BMD) in patients RA at the lumbar spine and the femoral neck. Methods This was a retrospective observational cohort study using patients with Rheumatoid arthritis attending for a regional dual X-ray absorptiometry (DEXA) scan at the Royal Lancaster Infirmary between 2004 and 2014. BMD in L1-L4 in the spine and in the femoral neck were recorded. The risk factors investigated were steroid use, family history of osteoporosis, smoking, alcohol abuse, BMI, gender, previous fragility fracture, number of FRAX(tm) risk factors and age. Univariate and Multivariate regression analysis models were fitted to explore bone loss at these sites using BMD in g/cm2 as a dependant variable. . Results 1,527 patients were included in the analysis, 1,207 (79%) were female. Mean age was 64.34 years (SD11.6). mean BMI was 27.32kg/cm2 (SD 5.570) 858 (56.2%) had some steroid exposure . 169(11.1%) had family history of osteoporosis. fragility fracture history found in 406 (26.6%). 621 (40.7%) were current or ex smokers . There was a median of 3 OP risk factors (IQR 1,3) The performance of the models is shown in table one below. Different risk factors appeared to influence the BMD at different sites and the cumulative risk factors influenced BMD in the spine. None of the traditional risk factors predicted poor bone loss well in this cohort. P129 Table 1:result of the regression modelsCharacteristicB femoral neck95% CIpB spine95%CIpAge at scan-0.004-0.005,-0.003<0.01-0.0005-0.002,0.00050.292Sex-0.094-0.113,-0.075<0.01-0.101-0.129,-0.072<0.01BMI (mg/m2)0.0080.008,0.0101<0.010.01130.019,0.013<0.01Fragility fracture-0.024-0.055,0.0060.12-0.0138-0.060,0.0320.559Smoking0.007-0.022,0.0350.650.0286-0.015,0.0720.20Alcohol0.011-0.033,0.0 5560.620.0544-0.013,0.1120.11Family history of OP0.012-0.021,0.0450.470.0158-0.034,0.0650.53Number of risk factors-0.015-0.039,0.0080.21-0.039-0.075,-0.0030.03steroids0.004-0.023,0.0320.030.027-0.015,0.0690.21 Conclusion This study has shown that predictors of low BMD in the spine and hip are different and less influential than expected in this cohort with RA . As the FRAX(tm) tool only uses the femoral neck, this might underestimate the fracture risk in this population. Further work looking at individual areas is ongoing. Disclosure M.A. Swar: None. M. Bukhari: None.

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TO DETERMINE THE PREVALENCE OF LOW BONE MINERAL DENSITY (OSTEOPENIA AND OSTEOPOROSIS) IN INDIAN PATIENTS WITH CIRRHOSIS OF LIVER AWAITING LIVER TRANSPLANTATION AS PER CURRENTLY USED HOLOGIC DXA DATABASE

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i4.1872 ◽

2021 ◽

Vol 5 (4) ◽

Author(s):

Sharad Deshmukh ◽

Suchita Deshmukh ◽

Sarojni A Parameswran ◽

P Pirmanayagam ◽

N Murgan ◽

...

Keyword(s):

Bone Mineral Density ◽

Liver Transplantation ◽

Lumbar Spine ◽

Bone Mineral ◽

Mineral Density ◽

Low Bone Mineral Density ◽

Indian Patients ◽

History Of ◽

The Mean ◽

Cirrhosis Of Liver

Background: Abnormalities in the bone metabolism observed in chronic liver disease are referred to as hepatic osteodystrophy. Osteoporosis and osteopenia are each part of this condition. Both conditions have a significant impact on morbidity, causing fractures that may result in chronic pain, long-lasting immobility, and deformity. Prevalence of fracture in patients with liver transplantation ranges from 15% - 65%. A high rate of fracturing is seen within the initial 1–2 years after transplantation. Aim: To determine the prevalence of low bone mineral density (osteopenia and osteoporosis) in Indian patients with cirrhosis of liver awaiting liver transplantation as per currently used Hologic DXA database Methods: This was a prospective observational study done at the department of gastroenterology and hepatology, Apollo Hospitals, Chennai from April 2011 to March 2013. All patients who fulfilled the inclusion criteria underwent detailed history taking, physical examination and relevant laboratory investigations. One hundred patients were selected for the scope of the study. Results: Sixty-eight per cent of patients were in the age group of 45 to 65 years. The mean age ± SD of the study subjects was 51.2 ± 9.7 years. The mean age for male patients was 50.5 ± 10.1 years, and for females was 54 ± 7.3 years. Cirrhosis was due to alcohol in 36% of the patients, viral hepatitis in 28% (HBV in 10% and HCV in 18%) patients. 42% were in Child’s class B, and the remaining 58% were in Child’s class C. MELD score was less than 20 in 62% patients. One third was diabetic; one third gave the history of backache. History of smoking was present in one fifth (20%) patients, and a history of fracture (most of them were traumatic) was present in 13% of patients. By using Hologic DXA database at the lumbar spine, osteopenia and osteoporosis were diagnosed in 44% and 38 % patients respectively. At the femoral neck, osteopenia and osteoporosis were diagnosed in 45% and 9% of patients. By using ICMR database at the lumbar spine, osteopenia and osteoporosis were diagnosed in 38% and 17% patients respectively. Similarly, at the femoral neck, osteopenia and osteoporosis were diagnosed in 34% and 5%. By using the Hologic DXA database, osteopenia and osteoporosis were diagnosed in 42% and 40 % patients. By using ICMR database, osteopenia and osteoporosis were diagnosed in 43% and 19% patients respectively. Conclusion: In light of the above results, the present study revealed a high prevalence of low bone mineral density (osteopenia and osteoporosis) in Indian patients with cirrhosis of liver awaiting liver transplantation. The lumbar spine was the most frequently and severely affected site in hepatic osteodystrophy. Keywords: Osteopenia, Osteoporosis, Low Bone Mineral Density, Liver Cirrhosis

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Low Bone Mineral Density in Elite Female Athletes With a History of Secondary Amenorrhea in Their Teens

Clinical Journal of Sport Medicine ◽

10.1097/jsm.0000000000000571 ◽

2018 ◽

Vol Publish Ahead of Print ◽

Cited By ~ 4

Author(s):

Sayaka Nose-Ogura ◽

Osamu Yoshino ◽

Michiko Dohi ◽

Mika Kigawa ◽

Miyuki Harada ◽

...

Keyword(s):

Bone Mineral Density ◽

Bone Mineral ◽

Female Athletes ◽

Mineral Density ◽

Secondary Amenorrhea ◽

Low Bone Mineral Density ◽

History Of

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AB0913 PREDICTING PATIENTS AT RISK OF FRAGILITY FRACTURE WITH NORMAL BONE MINERAL DENSITY: AN OBSERVATIONAL STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4544 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1758.1-1758

Author(s):

C. Saleh ◽

M. Bukhari ◽

S. M. Bilgrami

Keyword(s):

Rheumatoid Arthritis ◽

Bone Mineral Density ◽

Logistic Regression ◽

Fracture Risk ◽

Bone Mineral ◽

Fat Mass ◽

Fragility Fracture ◽

Odds Ratio ◽

Mineral Density ◽

History Of

Background:There is an increased risk of low-trauma fracture as bone mineral density (BMD) decreases, however a large proportion of these fragility fractures occur in those without osteoporosis or osteopenia. The widely used FRAX tool uses femoral neck (FN) BMD, amongst other parameters, to predict fracture risk. In those with normal BMD, data is lacking on the weight these other parameters hold in predicting future risk. Indeed, FN BMD can be facultative in the estimation of risk when using FRAX.Objectives:To establish predictors of fragility fracture in a patient cohort referred for BMD estimation, subsequently found to have bilateral FN BMD of greater than 1.Methods:A cohort of patients in the North West of England referred between 2004 and 2014 for BMD estimation, with both left and right FN BMD of greater than 1 were identified. Patient parameters identified and analysed included age at scan, gender, BMD at left hip, body mass index (BMI), fat mass, family history of fracture, alcohol history of 3 or more units per day, smoking status, rheumatoid arthritis (RA), and steroid exposure. Patients with fragility fracture were compared with those without fracture. Chi-square test and T-test were applied to categorical and continuous data respectively. Further univariate and multivariate logistic regression models were fitted to determine parameters associated with future fracture risk.Results:619 patients with bilateral FN BMD of greater than 1 were identified and included in analysis. Mean age at scan was 54 years (SD 11.82) and 542 (87.56%) were female. 92 (14.86%) patients had a fragility fracture. Mean left FN BMD was 1.91 (SD 0.71), and mean right FN BMD was 1.92 (SD 0.68). Results of the univariate analysis are described in Table 1 below.Table 1.Logistic regression analysis of patient parameters with unadjusted and adjusted odds ratios for fragility fracturePredictorUnadjusted odds ratio (95% CI)Odds ratio adjusted for age (95% CI)Odds ratio adjusted for age and gender (95% CI)Age at scan (years)0.99 (0.98-1.01)--Gender1.37 (0.66, 2.84)1.34 (0.64, 2.80)-BMD at left hip0.34 (0.03, 4.05)0.37 (0.03, 4.37)0.50 (0.03, 7.67)BMI1.07 (1.03, 1.10)1.07 (1.03, 1.10)1.07 (1.03, 1.10)Fat mass1.00 (1.00, 1.00)1.00 (1.00, 1.01)1.00 (1.00, 1.01)Parent fractured hip0.99 (0.57, 1.70)0.97 (0.56, 1.68)0.94 (0.54, 1.64)Alcohol (3 or more units/day)1.16 (0.47, 2.86)1.16 (0.47, 2.87)1.16 (0.47, 2.89)Current smoker1.40 (0.89, 2.21)1.40 (0.89, 2.21)1.42 (0.90, 2.23)Rheumatoid arthritis0.83 (0.32, 2.19)0.85 (0.32, 2.24)0.86 (0.34, 2.27)Steroid exposure0.53 (0.30, 0.96)0.53 (0.30, 0.96)0.54 (0.30, 0.98)Conclusion:Steroid exposure and body composition parameters influence fracture risk in this group pf patients with normal BMD, further work will be done looking at the types of fractures and other parameters in this group of patients.Disclosure of Interests:Christopher Saleh: None declared, Marwan Bukhari Speakers bureau: Bristol-Myers Squib, UCB celltech, Roche/Chugai, Pfizer, Abbvie, Merck, Mennarini, Sanofi-aventis, Eli-Lilly, Janssen, Amgen and Novartis., Syed Mujtaba Bilgrami Speakers bureau: Pfizer

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Asymptomatic vertebral fractures in patients with low bone mineral density

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.62.02.145 ◽

2016 ◽

Vol 62 (2) ◽

pp. 145-150 ◽

Cited By ~ 1

Author(s):

Caio Cesar Leite de Negreiros ◽

Marina Guareschi Berigo ◽

Robson Luiz Dominoni ◽

Deisi Maria Vargas

Keyword(s):

Bone Mineral Density ◽

Bone Mineral ◽

Vertebral Fractures ◽

Cross Sectional Study ◽

Vertebral Fracture Assessment ◽

Mineral Density ◽

Cross Sectional ◽

Test Technique ◽

Low Bone Mineral Density ◽

History Of

Summary Objective: Vertebral fracture assessment (VFA) is a test technique that can be used to detect asymptomatic vertebral fractures (AVF). It uses dual energy X-ray bsorptiometry (DXA) and can be performed concurrently with bone densitometry. This study aims to assess the prevalence of AVF in patients with low bone mass. Methods: Cross-sectional study including 135 individuals with low bone mineral density (BMD) with a T-score < -2.0 standard deviation (SD) in a densitometry clinic located in the city of Blumenau (state of Santa Catarina). Anthropometric, clinical and lifestyle variables were obtained from history-taking and physical examination. Densitometric variables were obtained by bone mineral densitometry and VFA (Explorer, Hollogic®). Vertebral fractures were classified according to the Genant criteria. Student's t, chi-square and logistic regression were performed for statistical analysis. Results: AVFs occurred in 24.4% of the subjects. They were older compared to those without AVF (65±9.25 versus 60.1±8.66; p=0.005), and had a history of lowimpact fractures (38.24% versus 19.8%; OR 2.5; p=0.03). Half of the patients that reported steroid therapy had AVFs, compared to one fifth of those who did not use steroids (50% versus 21.49%; OR 3.6; p=0.01). Conclusion: Asymptomatic vertebral fractures were present in approximately one fourth of patients. The risk factors associated were history of low-impact fracture, use of steroids and age > 61 years.

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THU0699 Predictors of fracture and low bone mineral density in patients with history of parental fracture

10.1136/annrheumdis-2018-eular.2286 ◽

2018 ◽

Author(s):

M. Dey ◽

M. Bukhari

Keyword(s):

Bone Mineral Density ◽

Bone Mineral ◽

Mineral Density ◽

Low Bone Mineral Density ◽

History Of

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Evaluation of Provider Screening Practices for Fracture Risk Assessment among Patients with HIV Disease

AIDS Research and Treatment ◽

10.1155/2021/6672672 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Faryal Mirza ◽

Sabina Zawadzka ◽

Anne Abbate ◽

Michael Thompson ◽

Dorothy Wakefield ◽

...

Keyword(s):

Bone Mineral Density ◽

Fracture Risk ◽

Bone Mineral ◽

Fragility Fracture ◽

People Living With Hiv ◽

Mineral Density ◽

Screening Practices ◽

Low Bone Mineral Density ◽

Increased Risk ◽

Provider Survey

People living with HIV are known to have greater risk of low bone mineral density than HIV-negative peers. The reasons for this disparity are multifactorial. To address this increased risk, the Infectious Diseases Society of America (IDSA) released fracture risk screening recommendations in 2015, which differ significantly from recommendations that apply to the general population. A study was conducted at the University of Connecticut to assess for provider awareness and adherence to these recommendations. Electronic surveys were sent to providers, and patients were also surveyed for risk factors and prevalence of low bone mineral density. The results of the provider survey showed low rates of awareness of the IDSA screening recommendations. A substantial proportion of patients surveyed met criteria for low BMD screening but did not have dual-energy X-ray absorptiometry (DXA) ordered by their provider. As an intervention, providers were sent information via e-mail regarding current screening recommendations, as well as notifications if their patient met criteria for DXA screening. A twelve-month follow-up survey showed increased provider knowledge of screening recommendations and improved screening practices. Additionally, the results of a logistic regression analysis of patient factors showed that increasing age and male sex were positively associated with fragility fracture risk. Increased duration of antiretroviral therapy use was associated with a lower likelihood of fragility fracture.

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Prevalence of subclinical contributors to low bone mineral density and/or fragility fracture

Acta Endocrinologica ◽

10.1530/eje-13-0102 ◽

2013 ◽

Vol 169 (2) ◽

pp. 225-237 ◽

Cited By ~ 29

Author(s):

Cristina Eller-Vainicher ◽

Elisa Cairoli ◽

Volha V Zhukouskaya ◽

Valentina Morelli ◽

Serena Palmieri ◽

...

Keyword(s):

Bone Mineral Density ◽

Bone Mineral ◽

Fragility Fracture ◽

Fragility Fractures ◽

Hypovitaminosis D ◽

Urinary Calcium ◽

Idiopathic Hypercalciuria ◽

Primary Osteoporosis ◽

Mineral Density ◽

Low Bone Mineral Density

ObjectiveThe prevalence of subclinical contributors to low bone mineral density (BMD) and/or fragility fracture is debated. We evaluated the prevalence of subclinical contributors to low BMD and/or fragility fracture in the presence of normal 25-hydroxyvitamin D (25OHVitD) levels.DesignProspective observational study.MethodsAmong 1095 consecutive outpatients evaluated for low BMD and/or fragility fractures, 602 (563 females, age 65.4±10.0 years) with apparent primary osteoporosis were enrolled. A general chemistry profile, phosphate, 25OHVitD, cortisol after 1-mg overnight dexamethasone suppression test, antitissue transglutaminase and endomysial antibodies and testosterone (in males) were performed. Serum and urinary calcium and parathyroid hormone levels were also evaluated after 25OHVitD levels normalization. Vertebral deformities were assessed by radiograph.ResultsIn total, 70.8% of patients had low 25OHVitD levels. Additional subclinical contributors to low BMD and/or fragility fracture were diagnosed in 45% of patients, with idiopathic hypercalciuria (IH, 34.1%) and primary hyperparathyroidism (PHPT, 4.5%) being the most frequent contributors, apart from hypovitaminosis D. Furthermore, 33.2% of IH and 18.5% of PHPT patients were diagnosed only after 25OHVitD levels normalization. The subclinical contributors to low BMD and/or fragility fracture besides hypovitaminosis D were associated inversely with age (odds ratio (OR) 1.02, 95% CI 1–1.04, P=0.04) and BMI (OR 1.1, 95% CI 1.05–1.17, P=0.0001) and directly with fragility fractures (OR 1.89, 95% CI 1.31–2.73, P=0.001), regardless of BMD.ConclusionsSubclinical contributors to low BMD and/or fragility fracture besides hypovitaminosis D are present in more than 40% of the subjects with apparent primary osteoporosis. Hypovitaminosis D masks a substantial proportion of IH and PHPT patients.

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Efficacy and safety of once-monthly ibandronate treatment in patients with low bone mineral density – ESTHER study: 24 months of follow-up

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1212722s ◽

2012 ◽

Vol 140 (11-12) ◽

pp. 722-727 ◽

Cited By ~ 2

Author(s):

Katarina Simic-Pasalic ◽

Study ESTHER

Keyword(s):

Bone Mineral Density ◽

Bone Mineral ◽

Economic Problem ◽

Activity Level ◽

New Drugs ◽

Efficacy And Safety ◽

Mineral Density ◽

Low Bone Mineral Density ◽

History Of

Introduction. Osteoporosis is a major health and economic problem worldwide. The use of new drugs, such as ibandronate, is aimed at improving treatment of osteoporosis and currently poor compliance with BP therapy. Objective. To investigate efficacy and safety of ibandronate applied monthly, orally, in women with low bone mineral density (BMD). Methods. The prospective study was conducted in 34 centers in Serbia and included 77 women treated for 24 months with monthly ibandronate. The efficacy of treatment was assessed by change in bone mass values obtained by BMD measurement at the end of 24 months follow-up versus baseline and 12-months follow-up values. Compliance and safety, i.e. adverse effects (AE) were recorded. Results. Participants were postmenopausal (96%), osteoporotic (79.7%) females, diagnosed by lumbar spine DXA measurement (81%), with history of prior BP therapy in 33.8% women. The physical activity level significantly increased to the substantial level of activity (5.2% vs. 21.3%, p=0.003) during the study. After 12 and 24 months of treatment, BMD values significantly increased (p=0.002 and p<0.001). BP experienced patients improved more than BP na?ve patients at both time points (p=0.012 and p=0.027, respectively). During the second 12 months of treatment the adherence was 96%; AE were recorded as mild gastrointestinal disturbances in 3.9%. Conclusion. Treatment by using ibandronate once monthly for 24 months was generally well tolerated and led to a significant increase in BMD in women with low BMD.

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