scholarly journals Comparison of osteoporotic fracture risk in surgical and natural menopausal patients

2021 ◽  
Vol 67 (3) ◽  
pp. 322-327
Author(s):  
Ayça Utkan Karasu ◽  
Yetkin Karasu ◽  
Müzeyyen Gülnur Özakşit ◽  
Yusuf Üstün ◽  
Yaprak Üstün Engin
Keyword(s):  
Hip Fracture ◽  
Femoral Neck ◽  
Fracture Risk ◽  
Osteoporotic Fracture ◽  
Assessment Tool ◽  
Lumbar Vertebrae ◽  
Mineral Density ◽  
Natural Menopause ◽  
T Score ◽  
Surgical Menopause

Objectives: This study aims to compare the fracture risk calculated with Fracture Risk Assessment Tool (FRAX®) in patients with natural and surgical menopause. Patients and methods: Between April 2019 and July 2019, 285 postmenopausal patients (mean age 57.3 years; range, 40 to 78 years) who were admitted to the menopause clinic were enrolled in this prospective cross-sectional study. Of these, 220 were in natural menopause and 65 were in surgical menopause. Demographic data, medical history, and International Physical Activity Questionnaire scores were collected through face-to-face interviews with the patients. Femoral neck and lumbar vertebrae (L1-L4) T-scores were evaluated using dual-energy X-ray absorptiometry. Fragility fracture risk was assessed using FRAX®. Results: The groups were similar in terms of age, body mass index, duration of menopause, smoking, alcohol use, and history of fracture (p>0.05). The risk of major osteoporotic fracture and hip fracture calculated without adding bone mineral density (BMD) was similar between groups (p=0.417 and p=0.234). The risk of hip fracture calculated with the addition of BMD was higher in natural menopause patients (p=0.023). Lumbar vertebrae T-scores were similar between two groups regardless of age; femoral neck T-scores were higher in surgical menopause (T-score=-0.8) than natural menopause group (T-score=-1.25) aged under 60 years, whereas this difference disappeared after 60 years of age. Conclusion: In our study, the fracture risk and the severity of osteoporosis were not different in surgical menopausal patients compared to the natural menopausal patients. Hip fracture risk calculated using BMD was lower in patients under 50 years of age in surgical menopausal patients. However, the fracture risks were similar in both groups after 50 years of age.

scholarly journals POS1106 FRAX AND THE EFFECT OF TERIPARATIDE ON BONE MINERAL DENSITY IN SECONDARY OSTEOPOROSIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 833.2-834
Author(s):  
S. Garcia ◽  
B. M. Fernandes ◽  
M. Rato ◽  
F. Oliveira Pinheiro ◽  
D. Fonseca ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Hip Fracture ◽  
Lumbar Spine ◽  
Femoral Neck ◽  
Fracture Risk ◽  
Bone Mineral ◽  
Fracture Probability ◽  
Mineral Density ◽  
T Score

Background:Teriparatide has been shown to increase spine and hip bone mineral density (BMD) and to reduce vertebral and non-vertebral fractures. (1) It is currently not clear whether the effect of teriparatide is dependent on the baseline risk of fracture or osteoporosis (OP) type, a finding that could have an impact on our therapeutic decision.Objectives:Investigate if there is a relationship between teriparatide effect in BMD and baseline 10-year fracture probability, assessed using FRAX®, in primary and secondary OP patients.Methods:This is a longitudinal, retrospective study including consecutive patients with the diagnosis of OP treated with teriparatide for 24 months, with a ten-year follow-up period, at our rheumatology department. Demographic, clinical, laboratorial, BMD and occurrence of fracture data were collected. The 10-year risk of osteoporotic fracture was estimated using the fracture risk assessment tool (FRAX) v 4.1 with the Portuguese population reference. Statistical analysis was performed using the software SPSS 23.0. Correlations between continuous variables were evaluated with spearman coefficient. p<0.05 was considered statistically significant.Results:Eighty patients (88.8% female, median age 65.00 (59; 75)) were included. Forty-nine patients (61.3%) has secondary OP, mainly of cortisonic etiology (61.2%, n=30). Before treatment, median lumbar spine BMD was 0.870 [0.767, 0.964] g/cm2, median T-score of -2.60 (-3.30, -1.90); median total femur BMD was 0.742 [0.667, 0.863] g/cm2, median T-score of -2.10 (-2.80, -1.30); median femoral neck BMD was 0.671 [0.611, 0.787] g/cm2, median T-score of -2.50 [-3.20, -1.85]. Regarding fracture risk, median FRAX-based 10-year major fracture risk (with BMD) at baseline was 16% [10.0; 23], and median hip fracture risk was 7.2% [3.4; 13.8].The median variation of BMD, after finishing teriparatide treatment, in the spine was 0.107 [0.029; 0.228]; median BMD variation in total femur was 0.013 [-0.013; 0.068] and median BMD femoral neck was 0.046 [-0.002; 0.109]. We observed a numerically superior effect, albeit without any statistical significance, of teriparatide on bone mineral density gain in secondary OP (versus primary OP) at lumbar spine, total femur and femoral neck.Most patients continued anti-osteoporotic treatment with a bisphosphonate (81.2%, n=65) and, during follow-up, 17 patients had an incident fracture (8 hip fractures and 6 vertebral fractures), median of 5 [1.75, 8.25] years after ending teriparatide.We found a discrete correlation between FRAX-based hip fracture probability and the variation of bone mineral density in total femur (Spearman’s coefficient 0.248, p = 0.04). There was no correlation between FRAX-based major fracture probability and and the variation of bone mineral density in the spine or femur. When we separately analyze the relationship between the variation in total hip BMD and the FRAX-based fracture risk, depending on whether it is a secondary or primary OP, we find that the correlation is stronger and only remains in secondary OP (Spearman’s coefficient 0.348, p = 0.03).Conclusion:Our data suggest that teriparatide could be an important weapon in the treatment of secondary cause OP, particularly cortisonic, and in patients at high fracture risk, although further larger studies are needed to confirm these findings.References:[1]Kendler DL, Marin F, Zerbini CAF, Russo LA, Greenspan SL, Zikan V, Bagur A, Malouf-Sierra J, Lakatos P, Fahrleitner-Pammer A, Lespessailles E, Minisola S, Body JJ, Geusens P, Möricke R, López-Romero P. Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet. 2018 Jan 20;391(10117):230-240. doi: 10.1016/S0140-6736(17)32137-2.Disclosure of Interests:None declared.

scholarly journals SAT0094 ASSESMENT OF BONE MINERAL DENSITY AND FRACTURE RISK IN PATIENTS WITH RHEUMATOID ARTHRITIS AND SARCOPENIA

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 980.2-981
Author(s):  
O. Dobrovolskaya ◽  
Z. Kolkhidova ◽  
A. Menshikova ◽  
N. Demin ◽  
N. Toroptsova
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Mineral Density ◽  
Hip Fracture ◽  
Femoral Neck ◽  
Fracture Risk ◽  
Bone Mineral ◽  
Osteoporotic Fracture ◽  
Proximal Femur ◽  
Mineral Density ◽  
Major Osteoporotic Fracture

Background:The problem of sarcopenia (SP) in rheumatoid arthritis (RA) is particularly significant in terms of assessing the risk of fractures, since SP leads to falls, which are an independent risk factor for fractures along with RA and osteoporosis.Objectives:To evaluate the bone mineral density (BMD) and fracture risk in women with RA and SP.Methods:79 women with RA based on the 2010 ACR/EULAR classification criteria were included: 20 (25%) women with confirmed SP (age median 59 [53; 64]) according to EWGSOP2 criteria and 59 (75%) women without SP (age median 60 [55; 67]) (p>0.05). We assessed clinical data: age, body mass index (BMI), disease duration, anthropometric measurements, C-reactive protein level, disease activity score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR), previous medication use including glucocorticoids and methotrexate, muscle strength and function. Dual-energy X-ray absorptiometry (DXA) to measure BMD of lumbar spine (LS), femoral neck (FN) and total hip (TH) was performed. The 10-year probability of major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture) and the 10-year probability hip fracture was calculated using the Russian version of the FRAX® tool. Statistical analysis was performed using non-parametric methods. All patients signed an informed consent to participate.Results:Median BMD in LS was 0.892 [0.772; 1.024] g/cm2in patients with SP and 0.910 [0.785; 1.028] g/cm2- without SP (p>0.05). There was significant difference between groups in the proximal femur BMD: 0.760 [0.731; 0.826] g/cm2in TH and 0.681 [0.607; 0.703] g/cm2in FN in patients with SP and 0.838 [0.735; 0.921] g/cm2in TH and 0.719 [0.622; 0.804] g/cm2in FN in patients without SP (p=0.009 and p=0.048, respectively). The frequency of osteoporosis was 35% and 22% in patients with and without SP (p>0,05). The 10-year probability of major osteoporotic fracture with / without femoral neck BMD data was 22,0% [17,0; 32,0] / 19,5% [18,5; 22,5 and 13,3% [9,8; 18,5] / 12,8% [9,3; 17,0] in patients with SP and without SP (р<0.05) and the 10-year probability of hip fracture with / without femoral neck BMD data - 3,1% [3,0; 7,5] / 3,1% [2,3; 3,3] and 1,4% [0,9; 2,78] / 0,65 [0,4; 1,7], respectively (р<0.05).Conclusion:There were no differences in the frequency of osteoporosis between patients with SP and without SP, however women with SP had proximal femur BMD less than women without SP. The probability of major osteoporotic fracture and hip fracture was significantly higher in patients with RA and SP compared with patients without SP.Disclosure of Interests:None declared

scholarly journals Comparison of Methods to Improve Fracture Risk Assessment in Chinese Diabetic Postmenopausal Women: A Case-Control Study

2021 ◽  
Author(s):  
Zhangxin Wen ◽  
Ding Na ◽  
Chen Rong ◽  
Shuyin Liu ◽  
Qinyi Wang ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Femoral Neck ◽  
Fracture Risk ◽  
Postmenopausal Women ◽  
Assessment Tool ◽  
Characteristic Curve ◽  
Fracture Risk Assessment ◽  
Mineral Density ◽  
Current Standard ◽  
T Score

Abstract PurposeThis study compared the performance of three proposed Fracture Risk Assessment Tool (FRAX) alternatives to the current standard Chinese FRAX in predicting bone fracture risk in type 2 diabetic (T2DM) postmenopausal women, and to explore the optimal strategy to better predicted fracture risk in postmenopausal women with diabetes in China.MethodsWe recruited 434 patients from community-medical centers, 217 with T2DM and 217 without T2DM (non-T2DM). All participants completed self-reported questionnaires detailing their characteristics and risk factors. Bone mineral density (BMD) and spinal radiographs were evaluated. The China FRAX model calculated all scores. The area under the receiver operator characteristic curve (ROC-AUC) evaluated the sensitivity, specificity, and accuracy for predicting 10-year risk for major (MOF) and hip (OHF) osteoporotic fractures in T2DM patients. ResultsT2DM patients had higher BMD but lower average FRAX values than non-T2DM patients. The unadjusted FRAX ROC-AUC was 0.774, significantly smaller than that for 0.5-unit femoral neck T-score-adjusted FRAX (0.800; p = 0.004). Rheumatoid arthritis (RA; AUC = 0.810, p = 0.033) and T-score (AUC = 0.816, p = 0.002) adjustments significantly improved fracture prediction in T2DM patients. Conclusions: Femoral neck T-score adjustment might be the preferred method for predicting MOF and OHF in Chinese diabetic postmenopausal women, while RA adjustment only effectively predicted HF risk.ConclusionsFemoral neck T-score adjustment might be the preferred method for predicting MOF and OHF in Chinese diabetic postmenopausal women, while RA adjustment only effectively predicted HF risk.

scholarly journals BMD status of Postmenopausal Women in relation with BMI: A study with 93 cases

2016 ◽  
Vol 17 (2) ◽  
pp. 138-141
Author(s):  
Samira Sharmin ◽  
Mabubul Haque ◽  
Syedur Rahman Miah ◽  
Md Mahbub Ur Rahman ◽  
Jasmine Ara Haque ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Femoral Neck ◽  
Postmenopausal Women ◽  
Lumbar Vertebrae ◽  
The Body ◽  
Mineral Density ◽  
Cross Sectional ◽  
T Score ◽  
Minimal Trauma ◽  
The Mean

Objectives: Low bone mass is a common disorder in elderly population which predisposes to fracture with minimal trauma. This study was performed to find out the association between the Body Mass Index (BMI) and Bone Mineral Density (BMD) in postmenopausal women.Materials and Methods: This cross sectional study was carried out at Institute of Nuclear Medicine and Allied Sciences Comilla and Mitford, Dhaka over a period of 12 months from January 2013 to December 2013. A total 93 postmenopausal women were enrolled for this study. All postmenopausal women underwent a BMD scan of femoral neck and lumbar vertebrae using a Dual Energy X-ray Absorptiometry (DEXA). Participants were categorized into three groups according to their age and BMI. BMD were expressed base on T-score according to WHO criteria. The relation among BMI, age and BMD were assessed.Results: The results of this study showed that the mean age of the study group was 57.13±7.49 years with range of 46 to 75 years. The most postmenopausal women were in age group 55-65years. The mean BMI of the study subjects were 24.18±5.08 kg/m2 with a range of 15.62 to 36.20 kg/m2. Among 93 subjects osteopenia was greater at lumbar spine (45.2%) with T-score mean±SD-1.83±0.33 and osteoporosis at femoral neck (51.6%) with T-score mean ±SD-3.36±-0.67. Pearson’s correlation coefficient test showed inverse relationship between age and BMD both lumbar spine (r = -0.301, p = 0.003) and femoral neck (r = -0.303, p=0.003) whereas the positive relation between BMI and BMD both at lumbar spine (r=0.338, p=0.001) and femoral neck (r =0.343, p=0.001). These showed that with advancing age, BMD decreases and the risk of osteoporosis increases and with increasing BMI, BMD increases and risk of osteoporosis decreases.Conclusion: The findings of this study portrait that aging and low BMI are risk factors associated with bone loss. So preventive measure should be taken for high risk post menopausal women.Bangladesh J. Nuclear Med. 17(2): 138-141, July 2014

scholarly journals Bone Mineral Density Assessment Following Radiotherapy Related Insufficiency Fractures (RRIFs) of the Pelvis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A243-A243
Author(s):  
Victoria Chatzimavridou Grigoriadou ◽  
Claire Emily Higham
Keyword(s):  
Risk Factor ◽  
Hip Fracture ◽  
Fracture Risk ◽  
Fragility Fracture ◽  
Trabecular Bone Score ◽  
Insufficiency Fractures ◽  
Pelvic Radiotherapy ◽  
Mineral Density ◽  
T Score ◽  
Radiotherapy Dose

Abstract Background: Pelvic radiotherapy causes symptomatic Radiotherapy Related Insufficiency Fractures (RRIFs) in around 20% of patients. Pathophysiology and predisposing factors for RRIFs are not well understood. Some studies have determined low BMD/osteoporosis to be a risk factor but only a few utilised DXA assessment of BMD at baseline prior to radiotherapy or at the time of RRIF development. Primary or secondary interventions to prevent/treat RRIFs have not been assessed. Methods: Retrospective analysis of patients (n=44; 42F; median age 65.5yrs [IQR 55, 73]) who underwent a DXA (Hologic) scan (Lumbar Spine (LS) (L1-4), Total Hip (TH), Femoral neck (FN) and Trabecular Bone Score (TBS)) following a diagnosis of pelvic RRIF between 2010–2019 at a tertiary referral cancer centre in the UK. Patient characteristics and treatment history were assessed. Osteoporosis (T-score &lt;-2.5), osteopenia (T-score &lt;-1 &gt;-2.5) and normal BMD (T-score &gt;-1) were defined as per WHO classification. Results: Cancer diagnoses; cervical (n=17), endometrial (n=9), vaginal (n=6), anal (n=6), other (n=6). Cancer treatments; chemotherapy (n=36), surgery (n=22), brachytherapy (n=26). Conventional risk factors for osteoporosis; previous fragility fracture (n=9, one on bisphosphonate prior to RRIF), smoking (n=7), glucocorticoid use (n=4), parental hip fracture (n=3), alcohol excess (n=3) and hypogonadism (n=2 and 8 on HRT). Median BMI = 25.4 [22.8, 28.5] kg/m2. Median interval between initiation of radiotherapy and RRIF was 9.8 [7.1, 19.3] months and between RRIF and DXA 3.5 [2, 8] months. At the time of the RRIF, 5 had normal BMD, 20 had osteopenia and 16 osteoporosis. Three patients were &lt;40yrs at time of DXA (lowest Z-score -2 at LS in n=1). Median T-scores in LS, FN and TH were -1.8 [-2.8, -0.98], -1.65 [-2.4, -1.18] and -1.25 [-1.68, -0.5] respectively; N=24 had all Z-scores ≥-1. Median TBS T-score was -2.65 [-3.48, -2]. Median 10-yr hip fracture risk (FRAX HF) was 1.8% [0.7–4.1], major osteoporotic fracture risk (FRAX MO) was 8.9% [5.2- 13] (if RRIF included as FRAX risk factor: 2.9% [1–5] and 15% [8.7- 20] respectively). FRAX HF was ≥ 3% in n=14 and FRAX MO ≥ 20% in n=6 (accounting for RRIF: n= 20 and 12 respectively). Most patients therefore fell below the intervention threshold. Pelvic radiotherapy dose was negatively associated with LS BMD (p=0.0228). Body mass index was positively correlated with LS BMD (p=0.002). Discussion: Most patients did not have osteoporosis at the time of RRIF and overall had low fragility fracture risk as defined by FRAX. RRIFs can also occur with normal hip and spine BMD. Low BMD at the spine was however associated with higher pelvic radiotherapy dose. The mechanism of RRIFs is likely different to osteoporotic fragility fractures and whilst low BMD is a probable risk factor, further studies are required to fully understand their pathophysiology and how fracture risk should be best assessed in these patients.

scholarly journals ABSOLUTE FRACTURE RISK ASSESSMENT IN OUTPATIENTS WITH DISTAL RADIUS OSTEOPOROSIS

2012 ◽  
Vol 15 (3) ◽  
pp. 3-6
Author(s):  
A A Popov ◽  
M V Strunina ◽  
M V Telyushchenko
Keyword(s):  
Risk Assessment ◽  
Hip Fracture ◽  
Fracture Risk ◽  
Osteoporotic Fracture ◽  
Clinical Decision Making ◽  
Absolute Risk ◽  
Fracture Risk Assessment ◽  
Mineral Density ◽  
Major Osteoporotic Fracture ◽  
Test Sensitivity

Objectives: to assess the absolute fracture risk in outpatients with osteoporosis (OP) at distant radius. Methods: individual absolute fracture risk was assessed using FRAX tool without hip neck bone mineral density (BMD) input in 3082 subsequent subjects (2911 females and 171 males) aged from 40 to 95 (median age 60), calculated by Finnish population data. Distant radius BMD was estimated in all patients by DTX200. Results: 774 (25.1 %) patients had had history of low traumatic fractures. BMD≤- .5 SD was detected in 1659 cases, fracture history in 558 (33.6%) of them (OR = 2.21; 95 % CI 1.93-2.55). Median 10-year probability of a major osteoporotic fracture was 4.90 % (25- 75 %; 1.10 - 55.0) and 10-year probability of a hip fracture was 0.8 % (0 - 46), absolute risk 10 % and higher was detected in 434 (64,3 %) patients. Calculated 10-year probability of a major osteoporotic fracture > 10 % was associated with previous low traumatic fractures: OR = 4,55; 95 % CI 4,06- 5,10, test sensitivity being 56.1 % with specificity 89.6 % . The same association was found for 10-year probability of hip fracture >3 %: OR = 3.57 (3.19 - 4.00), test sensitivity being 51,6 % with specificity 86,7 %. Conclusion: FRAX tool for individual absolute fracture risk assessment should be introduced into general practice for clinical decision making in prophylaxis of OP associated fractures.

Comparison of FRAX score to bone mineral density for estimating fracture risk in patients with CRPC on androgen-deprivation therapy (ADT).

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 101-101
Author(s):  
Marc Nicolas Bienz ◽  
Herbert James ◽  
Ilija Aleksic ◽  
Christopher Michael Pieczonka ◽  
David Albala ◽  
...  
Keyword(s):  
Fracture Risk ◽  
Assessment Tool ◽  
Significant Risk ◽  
Mineral Density ◽  
X Ray ◽  
T Score ◽  
Fracture Risk Assessment Tool ◽  
Frax Score ◽  
Treatment Table ◽  
Country Specific

101 Background: A FRAX algorithm has been elaborated to estimate the ten-year hip fracture risk associated with this under-diagnosed condition. We aim to evaluate the fracture risk of patients who would otherwise be left untreated by the conventional T-score. Methods: Clinical data from 613 PCa patients undergoing ADT was collected from our AMP large urology group. Fracture risk was assessed using the country specific (USA) Fracture Risk Assessment Tool (FRAX). Also, a subset of patients (n=94) had received Dual-energy X-ray Absorptiometry (DXA). We compared the proportion of patients suitable for treatment according to the threshold of the FRAX fracture risk calculated with the BMD (>3%) and the T-score (<-2.5). Results: According to the FRAX algorithm (without BMD), 61.6% of our cohort require treatment. The FRAX score (with BMD) identified 46.8% of patients who had DXA suitable for treatment, in contrast to 19.1% by the T-score alone. Correlations were calculated between the various methods (Table). Conclusions: Our results demonstrate that many patients unidentified for treatment by the conventional T-score are at significant risk for fracture according to the FRAX algorithm with BMD. When calculated without the BMD, an even greater proportion of patients is found to be at risk and suitable for treatment. [Table: see text]

scholarly journals SAT0482 FRAX 10-YR FRACTURE RISK IN RHEUMATOID ARTHRITIS ASSESSED WITH AND WITHOUT BONE MINERAL DENSITY – ARE WE TREATING OUR PATIENTS UNDER bDMARDs?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1197.1-1198
Author(s):  
M. Rato ◽  
F. Pinheiro ◽  
S. Garcia ◽  
B. M. Fernandes ◽  
S. Ganhão ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Mineral Density ◽  
Hip Fracture ◽  
High Risk ◽  
Femoral Neck ◽  
Fracture Risk ◽  
Bone Mineral ◽  
Mineral Density ◽  
High Fracture ◽  
Erosive Disease

Background:Patients with rheumatoid arthritis (RA) have a higher risk of osteoporosis not only due to chronic inflammation status, but also due to the treatment with glucocorticoids. FRAX is a computer-based algorithm developed by the World Health Organization for estimation of the 10-year risk of a hip or major osteoporotic fracture. Inclusion of femoral neck bone mineral density (BMD) in the estimation is optional.Objectives:The study aimed to identify the RA patients under treatment with biological disease-modifying antirheumatic drug (bDMARD), who have FRAX scores, calculated with and without BMD, classified as high fracture risk and evaluate if they are receiving treatment for osteoporosis. The authors also investigated the intra-individual agreement between FRAX fracture risk calculated with and without BMD.Methods:Demographic and clinical data and BMD results from RA patients followed in a tertiary university hospital and registered in the Rheumatic Diseases Portuguese Register were used for analysis. Patients under 40 years of age at the last visit were excluded. McNemar test was applied for the identification of discordance of risk categories. The Wilcoxon test was used to characterize the intraindividual differences between paired FRAX risks with and without BMD. Correlations between pairs of variables were evaluated by the Spearman test. For independent variables Mann-Whitney test was used.Results:A total of 303 patients were included, 244 were females (80.5%) and 49 current smokers (16.2%). Mean age was 59.5 ± 9.54 years and mean disease duration 18.5 ± 10.4 years. Two hundred and twenty patients (72.4%) and 243 (80.2%) were RF and ACPA positive, respectively, and 51.5% had erosive disease. Mean disease activity score (DAS28-4V-CRP) was 3.08 ± 1.18 and mean femoral neck BMD 0.84 ± 0.12 g/cm2. One hundred and seventy nine patients (58.9%) were concomitantly treated with conventional synthetic DMARDs and 215 (70.7%) with glucocorticoids. Among all the patients, 35 (11.6%) had previous fractures and 19 (6.3%) have family history of fracture. The median 10-year risk of a major fracture and a hip fracture, calculated without BMD, was 6.0 (1.2-50) and 1.5 (0.1-39), respectively; with BMD it was 6.9 (1.3-61) and 1.7 (0-49). When FRAX score is calculated without BMD (n=303), 76 (25.1%) patients were categorized as high fracture risk. Among them, only 41 (54%) were receiving osteoporosis treatment. FRAX assessment with BMD (n=231) identified 99 (32.7%) patients with high fracture risk, 51 (51,5%) in treatment for osteoporosis. Thirty patients (21%) previously classified as low fracture risk using FRAX without BMD were recategorized as high risk (p<0.001). Despite that, there was a strong correlation between fracture risks assessed with and without BMD for both major and hip fracture (r = 0.867, p < 0.0001 and r = 0.728, p < 0.0001, respectively). ACPA and RF positive patients did not have higher FRAX scores (including or not BMA). Patients with erosive disease had a higher 10-year probability of major fracture evaluated by FRAX when it includes BMD (p=0.041).Conclusion:It is very important to accurately assess the risk of osteoporotic fractures in RA patients to treat them properly. The authors highlight the high number of patients who are not receiving treatment according to FRAX categorization. In spite of the correlation between estimated fracture risk by FRAX with and without BMD, there is a discordance in fracture risk categorization, as one fifth of patients of low risk were reclassified as high risk. For the RA population treated with bDMARDS, our findings raise the need to request a DXA not only for patients classified as having an intermediate risk of fracture, but also for low-risk patients.Disclosure of Interests:Maria Rato: None declared, Filipe Pinheiro: None declared, Salomé Garcia: None declared, Bruno Miguel Fernandes: None declared, Sara Ganhão: None declared, Rita Gaio: None declared, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Alexandra Bernardo: None declared, Lúcia Costa: None declared

scholarly journals The Impact of the “Osteo” Component of Osteosarcopenia on Fragility Fractures in Post-Menopausal Women

2021 ◽  
Vol 22 (10) ◽  
pp. 5256
Author(s):  
Yen-Huai Lin ◽  
Yu-Tai Shih ◽  
Michael Mu Huo Teng
Keyword(s):  
Fracture Risk ◽  
Assessment Tool ◽  
Bone Microarchitecture ◽  
Fragility Fractures ◽  
Mineral Density ◽  
High Fracture ◽  
T Score ◽  
Menopausal Women ◽  
Post Menopausal ◽  
The Impact

Osteosarcopenia, the coexistence of bone and muscle loss, is common in older adults, but its definition lacks international consensus. This cross-sectional study (n = 1199 post-menopausal women) aimed to determine the association between osteosarcopenia and fragility fractures and to investigate the impact of the definition of the “osteo” component. Bone mineral density and bone microarchitecture were measured by dual-energy X-ray absorptiometry and the trabecular bone score (TBS), respectively. The “osteo” component of osteosarcopenia was classified as osteoporosis (T-score ≤ −2.5 SD), osteopenia/osteoporosis (T-score < −1 SD), and high-fracture-risk osteopenia (−2.5 SD < T-score < −1 SD)/osteoporosis (T-score ≤ −2.5 SD). The Fracture Risk Assessment Tool was used to identify high-fracture-risk osteopenia. Altogether, 30.3%, 32.2%, 14.4%, and 23.1% of participants had osteosarcopenia, osteoporosis alone, sarcopenia alone, and neither condition, respectively. The odds ratios between osteosarcopenia and fragility fractures were 3.70 (95% CI: 1.94–7.04) for osteosarcopenia, 2.48 (95% CI: 1.30–4.71) for osteoporosis alone, and 1.87 (95% CI: 0.84–4.14) for sarcopenia alone. Women with osteosarcopenia also had lower TBS, indicating worse bone microarchitecture. In conclusion, women with osteosarcopenia were more likely to have previously sustained a fracture compared to those without osteosarcopenia, with sarcopenia alone, and with osteoporosis alone. The relationship between osteosarcopenia and fracture risk may be best identified when considering high-fracture-risk osteopenia and osteoporosis.

Ten-year fracture risk by FRAX and osteoporotic fractures in patients with systemic autoimmune diseases

Lupus ◽  
2019 ◽  
Vol 28 (8) ◽  
pp. 945-953 ◽  
Author(s):  
E -L Lai ◽  
W -N Huang ◽  
H -H Chen ◽  
C -Y Hsu ◽  
D -Y Chen ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Autoimmune Diseases ◽  
Fracture Risk ◽  
Osteoporotic Fracture ◽  
Lupus Erythematosus ◽  
Assessment Tool ◽  
Osteoporotic Fractures ◽  
Fracture Risk Assessment ◽  
Risk Scores ◽  
Mineral Density

The Fracture Risk Assessment Tool (FRAX) has been used universally for the purpose of fracture risk assessment. However, the predictive capacity of FRAX for autoimmune diseases remains inconclusive. This study aimed to compare the applicability of FRAX for autoimmune disease patients. This retrospective study recruited rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and primary Sjögren syndrome (pSS) patients with bone mineral density (BMD) tests. Patients with any osteoporotic fractures were identified. Taiwan-specific FRAX with and without BMD were then calculated. In total, 802 patients (451 RA, 233 SLE and 118 pSS) were enrolled in this study. The cumulative incidences of osteoporotic fractures in the RA, SLE and pSS patients were 43.0%, 29.2% and 33.1%, respectively. For those with a previous osteoporotic fracture, T-scores were classified as low bone mass. Overall, the patients’ 10-year probability of major fracture risk by FRAX without BMD was 15.8%, which then increased to 20.3% after incorporation of BMD measurement. When analyzed by disease group, the fracture risk in RA patients was accurately predicted by FRAX. In contrast, current FRAX, either with or without BMD measurement, underestimated the fracture risk both in SLE and pSS patients, even after stratification by age and glucocorticoid treatment. For pSS patients with major osteoporotic fractures, FRAX risks imputed by RA were comparable to major osteoporotic fracture risks of RA patients. Current FRAX accurately predicted fracture probability in RA patients, but not in SLE and pSS patients. RA-imputed FRAX risk scores could be used as a temporary substitute for SLE and pSS patients.

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