Background:Osteoporosis is a disease that affects bone mineral density (BMD) and bone microarchitecture at the origin of an increased risk of fracture. The reduction in bone density assessed by dual-energy X ray absorptiometry (DXA) and fall history represent the first two risk factors of non-vertebral fracture after menopause. Given the high prevalence of osteoporosis among fallers subjects with common risk factors, causing a surisk of fracture. Several publications including the osteoporosis recommendations indicate DXA in women experienced falls in search of bone fragility may justify a treatment for osteoporosis, especially as the FRAX tool does not include at present the fall of history, an important parameter in the assessment of fracture risk.Objectives:Because of the low attention given to the evaluation of falls’risk, the main objective of the study was to determine the prevalence and the relationship between the past history of fall, reduction of bone mineral density and prevalent fracture.Methods:Transversal and descriptive epidemiological cohort study conducted for 24 months in 448 patients referred by physicians regularly use prescription of BMD. The realization of this exploration by the same DXA-Hologic in the rheumatology department at Ibn Rochd University Hospital was the criterion for entry into the study. All patients were interviewed on the same day on the risk factors for osteoporosis and fractures justifying the prescription of a BMD.Results:Data included 413 women and 35 men. Most women were postmenopausal (89.6%). The average age was 59 years (σ = 13.40), 33.7% were ≥ 65 years. The mean BMI was at 27.50 (σ = 5,2). 18.5% of patients had at least a history of falls in the previous 12 months and 22.5% a history of fracture after a low-energy trauma. 42.9% were osteoporotic and 57.1% had osteopenia in at least one of these sites: lumbar spine, femoral neck, total hip. We did not find significant association between BMD osteoporosis and fall history (p = 0.916). Thus, cases of osteoporosis fractures were not statistically associated with a fall (p = 0.170). Also, the falls were occurring than 18.4% of osteopenic patients (p = 0.220). However, in our study, the fall was an independent risk factor for fracture (p = 0.003) and osteopenic fractures were significantly higher among fallers (p = 0.009 and 0.006 respectively, a drop of history and at least one past fall history).Conclusion:The fall history is a independent risk factor for fracture. This risk is particularly important in case of fragility bone densitometry. The clinical history and fall risk factors should be taken into consideration in the assessment of fracture risk and in the anti-ostoporotique treatment strategy. Thus, the fall seems to be a legitimate indication for DXA and as a parameter to be integrated into the assessment of fracture risk by the FRAX score.References:[1]MH. Edwards, K. Jameson, H. Denison, NC.Harvey, Sayer A. Aihie, EM Dennison, and C Cooper. Clinical risk factors, bone density and fall history in the predection of incident fracture among men and women. Bone. 2013; 52(2): 541–547.Table 1.Multivariate Logistic Regression Results: Adjustment for
predictors factors of fallsVariablesOR (95% IC)p-valueAge ≥ 65 ans0,986 (0,412-2,357)0,974Past history of fracture4,271 (1,719-10,611)0,02Walking aid11,214 (2,815-44,670)0,01Vision disturbances8,587 (3,540-20,829)<0,001Rhumatoid arthritis8,047 (2,218-29,192)0,02Diabete3,194 (1,217-8,382)0,018Corticosteroid ≥ 3 mois0,603 (0,156-2,331)0,463Smoking0,241 (0,013-4,518)0,341Ostéopenia (-1 ≤ T-score < -2,5)2,204 (0,875-5,552)0,094Disclosure of Interests:None declared.
DIAGNOSIS OF ENDOCRINE DISEASE: Evaluation of bone fragility in endocrine disorders
