Osteoporotic Vertebral Deformity: Radiological Appearances and Their Association With a History of Trauma and the Risk of Further Fragility Fracture

2020 ◽  
pp. 084653712095847
Author(s):  
Yì Xiáng J. Wáng
Keyword(s):  
Fragility Fracture ◽  
Vertebral Deformity ◽  
History Of

scholarly journals P129 Predictors of low bone mineral density in rheumatoid arthritis

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Malika A Swar ◽  
Marwan Bukhari
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Bone Mineral Density ◽  
Family History ◽  
Bone Loss ◽  
Femoral Neck ◽  
Bone Mineral ◽  
Fragility Fracture ◽  
Mineral Density ◽  
History Of

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.

scholarly journals History of Previous Fracture and Imminent Fracture Risk in Swedish Women Aged 55 to 90 Years Presenting With a Fragility Fracture

2020 ◽  
Vol 35 (5) ◽  
pp. 861-868 ◽  
Author(s):  
Emese Toth ◽  
Jonas Banefelt ◽  
Kristina Åkesson ◽  
Anna Spångeus ◽  
Gustaf Ortsäter ◽  
...  
Keyword(s):  
Fracture Risk ◽  
Fragility Fracture ◽  
Previous Fracture ◽  
History Of

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

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

scholarly journals Premenopausal Trabecular Bone Loss is Associated with a Family History of Fragility Fracture

2016 ◽  
Vol 76 (08) ◽  
pp. 895-901 ◽  
Author(s):  
J. Prior ◽  
C. Hitchcock ◽  
Y. Vigna ◽  
V. Seifert-Klauss
Keyword(s):  
Family History ◽  
Bone Loss ◽  
Trabecular Bone ◽  
Fragility Fracture ◽  
Trabecular Bone Loss ◽  
History Of

scholarly journals Management of Osteoporosis in The Community: How Well Can Family Physicians Do? A Retrospective Case Series in a Local Public Clinic in Hong Kong.

2020 ◽  
Author(s):  
Pui Kwan Chan ◽  
Vincent Li Wing Shun ◽  
Yim Chu Li ◽  
Catherine Chen Xiao Rui
Keyword(s):  
Primary Care ◽  
Hong Kong ◽  
Femoral Neck ◽  
Fragility Fracture ◽  
Case Series ◽  
Family Physicians ◽  
Bisphosphonate Treatment ◽  
Retrospective Case ◽  
T Score ◽  
History Of

Abstract BackgroundWith the ageing population, osteoporosis is increasingly becoming a global health concern. Previous research showed that management of osteoporosis in Hong Kong had been suboptimal. In view of the need to provide quality care to osteoporotic patients, a Multidisciplinary Osteoporosis Clinic (MOC) organized by primary care physicians was set up in a public primary care clinic. This study aimed to explore the clinical effectiveness of MOC.MethodsWe performed a retrospective case series study. All osteoporotic patients who had attended MOC during the period 1 January 2015 to 31 December 2018 were included. Changes in Dual X-ray absorptiometry (DEXA) T-score of recruited patients after two years of management at MOC were analysed. Subgroup analyses of the 2-year interval DEXA T-score changes among patient with or without history of fragility fracture, and among patients with or without pharmacological treatment , were performed. Serial interval DEXA T-score changes of recruited patients who had completed 5 years of bisphosphonate treatment were also analysed. Paired Student’s t test was used to analyze the interval DEXA T-score changes.ResultsTotally 186 osteoporotic patients were recruited. After two years of management at MOC, the T-score at lumbar spine and femoral neck were improved, from -2.71±0.76 to -2.35±0.83 and -2.40±0.75 to -2.10±0.76 respectively, P<0.001. For subgroup analysis on patients with or without history of fragility fracture and patients with or without bisphosphonate treatment, improvement in T-scores of both lumbar and femoral neck were all significant at two years, P<0.05. Among those who had completed 5 years of bisphosphonate treatment, progressive improvement in T-scores of both lumbar and femoral neck were observed, with P <0.001.ConclusionMOC run by family physicians in public primary care setting could effectively treat osteoporotic patients with significant improvement in DEXA T-scores.

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