Characteristics of osteoporosis in patients with rheumatic diseases

Aim. To present a comprehensive assessment of rheumatic diseases in association with osteoporosis.Material and methods. A retrospective analysis was made of 180 case histories with various RDs, who were under inpatient observation at the Sughd Regional Clinical Hospital for the period 2018-2019 for the frequency of osteoporosis (OP). Densitometry was used to determine the projection mineral density (in g / cm2) in various parts of the skeleton.Results. When asked about a history of fractures, every third respondent (33.3%) answered positively. According to the results of densitometry, osteoporosis in patients with inflammatory RD was diagnosed in 32.2% of patients. At the same time, the indicators differed significantly by nosology, and the frequency of OP correlated with the intake of corticosteroids. Osteoporosis was detected in every third patient with OA according to densitometry data and in 25% of cases in patients with gout. The results of the analysis to assess the absolute risk of major osteoporotic fractures according to FRAX showed high risk in 2 groups.Conclusion. Thus, the nature and frequency of risk factors for osteoporosis in patients with RA and OA have their characteristics. A history of fractures in patients with RA is often associated with long-term use of GCS, and the presence of menopause in women and the presence of cardiometabolic concomitant diseases play an important role in the progression of AP in patients with OA.

Ukrainian FRAX version in the male osteoporosis management

Background. At present, FRAX is a well-known and widely-used risk assessment tool for major osteoporotic fractures. The Ukrainian version of the FRAX algorithm was presented in 2016; with the “intervention threshold” for additional DXA exa­mination and antiosteoporotic treatment of the Ukrainian women published in 2019. However, the data on its possible uses in men are limited. The purpose of the study was to evaluate the possibilities of using the previously developed criteria of the Ukrainian FRAX algorithm in Ukrainian men. Materials and me­thods. We exa­mined 653 outpatients aged 40–88 years (mean age (M ± SD) — 60.5 ± 11.8 years). We analyzed the results both in the general group and in the age subgroups; in particular, with an account of low-trauma fractures, included in the FRAX calculation, and compared them with the corresponding indices of the Ukrainian wo­men. Results. The most frequent (26.6 %) risk factor for osteoporo­tic fractures in the group of Ukrainian men was a history of low-trauma fracture (the corresponding index in women was 51.3 %), its presence being the reason for antiosteoporotic treatment initia­ting. Following upon the risk of major osteoporotic fractures calculated by FRAX, only 6.7 % of men without previous fractures were found to require additional DXA examination in order to re-evaluate the osteoporotic fracture risk, and none had a high fracture risk. 73 % of men without fractures did not have any risk factor inclu­ded in the FRAX algorithm. Conclusions. This study showed a grea­ter need for both antiosteoporotic treatment without DXA assessment and additional densitometric examination for the osteoporotic fracture risk assessment for the Ukrainian women rather than men, along with a special attention to the presence of previous fractures in men, and consideration of other risk factors for osteoporosis, even those not included in this FRAX algorithm.

POS0131 10-YEAR PROBABILITY OF A MAJOR OSTEOPOROTIC FRACTURES IN WOMEN WITH OSTEOARTHRITIS OF THE KNEE JOINT

Background:The relationship between osteoporosis and osteoarthritis (OA) is complex and contradictory. Some studies suggest a protective effect of OA in osteoporosis [1-2]. However, other studies show that increased bone mineral density (BMD) in OA not only does not reduce the risk of fractures, but can also increase it [3-4].Objectives:To assess the 10-year probability of osteoporotic fractures using the FRAX calculator in women with OA of the knee joint.Methods:The study included 22 women (average age 63.7±1.01 years) diagnosed with ACP of the knee joint according to the ACR criteria (1991). The Control Group included 24 conditionally healthy women without OA knee joint, with an average age of 63.6±1.37 years.The BMD (g/cm2) and the T-criterion (standard deviation, SD) of the neck of the femur and lumbar spine (LI-LIV) were evaluated by the method of two-power X-ray absorption (DXA) (apparatus «Lunar Prodigy Primo», USA). 10-year probability of major osteoporotic fractures (clinically significant fracture of the spine, distal fracture of the forearm, fracture of the proximal femur, or fracture of the shoulder) and fracture of the proximal thigh with the FRAX calculator (version 3.5 for Russian population).Results:An osteopenic syndrome in the cohort under investigation was found in 42 (91.3%) patients, of whom osteopenia in 24 (52.2%) women and osteoporosis in 18 (39.1%). A normal BMD is registered in 4 (8.7%) patients.In the group of patients with knee joint OA, only 2 (9.1%) of women had a normal BMD, 11 (50.0%) of osteoporosis, and 9 (40.9%). Osteopenic syndrome is generally found in 20 (90,9%) patients.In the control group, osteopenic syndrome has been diagnosed in 22 (91,7%) of whom: osteopenia in 13 (54.2%), osteoporosis in 9 (37.5%) patients. Two (8.3%) women had a normal BMD. There were no statistically significant differences in the structure of the osteopenic syndrome among the studied groups (p=0.961).An analysis of the 10-year probability of major osteoporotic fractures found that women with OA knee joint had the above probability of 12.3±0.91, and in the control group 14.2±1.06 (p=0.085).The 10-year probability of fracture of the proximal femur in women with OA was statistically less significant than in the control group: 1.55 (0.70;1.98) and 2.10 (1.20;2.95), (p=0.031), respectively.Conclusion:The total incidence of the osteopenic syndrome in the cohort under investigation was 91.3% (90.9% in women with OA, 91.7% in the control group). The frequency of registration of osteopenia and osteoporosis in women with OA did not differ statistically significantly from the control group. The probability of major osteoporotic fractures within 10 years was comparable in these groups. The probability of a proximal femur fracture in women with OA was statistically significant, but not clinically significant, compared to the control group.References:[1]Yamamoto Y, Turkiewicz A, Wingstrand H, et al. Fragility Fractures in Patients with Rheumatoid Arthritis and Osteoarthritis Compared with the General Population. J Rheumatol. 2015 Nov;42(11):2055-8.[2]Vala CH, Kärrholm J, Kanis JA, et al. Risk for hip fracture before and after total knee replacement in Sweden. Osteoporos Int. 2020 May;31(5):887-895.[3]Kim BY, Kim HA, Jung JY, et al. Clinical Impact of the Fracture Risk Assessment Tool on the Treatment Decision for Osteoporosis in Patients with Knee Osteoarthritis: A Multicenter Comparative Study of the Fracture Risk Assessment Tool and World Health Organization Criteria. J Clin Med. 2019 Jun 26;8(7):918.[4]Soh SE, Barker AL, Morello RT, et al. Applying the International Classification of Functioning, Disability and Health framework to determine the predictors of falls and fractures in people with osteoarthritis or at high risk of developing osteoarthritis: data from the Osteoarthritis Initiative. BMC Musculoskelet Disord. 2020 Feb 29;21(1):138.Disclosure of Interests:None declared

AB0613 FREQUENCY AND RISK OF FRAGILITY FRACTURES IN PATIENTS WITH SYSTEMIC SCLEROSIS

Background:Objectives:To assess the frequency of fragility fractures and the 10-year risk of major osteoporotic fractures using the fracture risk assessment tool (FRAX) tool in patients with systemic sclerosis (SSc).Methods:The study included 136 patients with SSc who met the ACR/EULAR 2013 criteria: 110 (80.9%) postmenopausal women and 26 (19.1%) men over 50 years of age, mean age 59,3 + 7.5 years. The duration of the disease was 10,0 [6.0; 15.0] years in women and 6,0 [3.5; 9.0] years in men. A questionnaire was conducted and the risk of major osteoporotic fractures was calculated according to FRAX tool, as a result of which patients were divided into groups of low, moderate or high risk. Individuals at moderate risk underwent dual-energy X-ray absorptiometry (DXA) of the proximal femur, followed by a 10-year probability of major osteoporotic fractures recalculation with the inclusion of the femoral neck T-score. According to the obtained fracture risk assessment tool value, patients were assigned as having a low, high or very high risk.Results:Fragility fractures of various localization were found in 50 (36,7%) people: 41 (37,3%) women and 9 (34.6%) men. Vertebral and peripheral bone fractures occurred with the same frequency (19,8%) without significant differences depending on the patient’s gender. Only 1 (3,8%) male had a history of proximal femoral fracture. Fractures of both the vertebra and the peripheral bone occurred in 4 (2,9%) people: 3 (2,7%) women and 1 (3,8%) man.9 (8,2%) women and 16 (61,5%) men had a low risk of major osteoporotic fractures according to FRAX, 60 (54,5%) and 10 (38,5%) - a moderate risk, respectively, while 41 (37,3%) women were at high risk. Among 86 patients without a history of low-energy fractures (69 women and 17 men), 8 (11,6%) women and 16 (94,1%) men were at low risk of major osteoporotic fractures, and 57 (82,6%) and 1 (5,9%), respectively, were at moderate risk. Only 4 (5,8%) women were assigned to the high-risk group. After recalculation of the fracture risk assessment tool with inclusion of the femoral neck T-score in persons with moderate risk without a history of fragility fractures, 9 (13,0%) women and 1 (5,9%) man were found to be at high risk, 14 (20,3%) women - at very high risk and 34 (49,3%) women - at low risk.Among moderate-risk patients with prior fractures after FRAX recalculation 3 (7,3%) women and 7 (77,8%) men became at low risk, 1 (11,1%) male - at high and 1(11,1%) male – at very high risk. Thus, 55 (50,0%) women and 1 (3,8%) man were at very high, 12 (10,9%) and 2 (7,7%), respectively, - at high, and 43 (39,1%) and 23 (88,5%), respectively, - at low risk of major osteoporotic fractures.Conclusion:In the examined cohort of patients with SSc, the frequency of fragility fractures was 37,3% in women and 34,6% in men. A high and very high risk of major osteoporotic fractures was found in 60,9% of women and 11,5% of men. 3 (2,7%) women and 6 (23,1%) men with a history of previous fractures were in the low-risk group by FRAX, but they need to consider the appointment of anti-osteoporotic therapy as for patients at high and very high risk.Disclosure of Interests:None declared.

POS1116 ENHANCING OSTEOPOROSIS MANAGEMENT: THE CONTRIBUTION OF FRAX® AND VFA IN TUNISIAN WOMEN

Background:The FRAX® is a tool proposed by the World Health Organization (WHO) to calculate 10-year fracture risk of hip fracture and major osteoporotic fractures. The utility of this tool is to help treatment decision when it is litigious. Previous low trauma fracture represent a factor in FRAX® calculation. However, asymptomatic osteoporotic vertebral fractures (VF) identified on X-rays or Vertebral Fracture Assessment (VFA) scans are rarely included. To the best of our knowledge, there was no previous evaluation of fracture risk in Tunisian women.Objectives:To compare hip fracture risk and major osteoporotic fractures risk using the FRAX® tool, without and with the consideration of asymptomatic VF on VFA. To evaluate the impact of FRAX® calculation and asymptomatic VF identified on VFA on osteoporosis management.Methods:We conducted a cross-sectional study over a period of 5 months at the rheumatology department. The study included post-menopausal women without a previous diagnosis of VF referred for BMD (Bone mineral density) measurement. Each participant had a BMD assessment and a VFA scan to detect VF. The FRAX® was calculated using femoral neck BMD initially without then with consideration of VF. The change of therapeutic decision was assessed after taking into consideration FRAX® and the VFA results.Results:The study included 210 post-menopausal women with a mean age of 61.5±8.5 years. The mean BMI was 31.04±5.52 kg/m2. One women was a current smoker and alcohol intake was not found in our sample. Thirty-seven percent of our participants had at least one fragility fracture. A severe fragility fracture was recorded in 10.5% and a previous hip fracture was reported in 5.24%. An early menopause was found in 19.5% of our women. Twenty percent of our population were receiving corticosteroids and 8.2% of our population had rheumatoid arthritis. The mean vertebral and total hip BMD was 0.955±0.165 g/cm2 and 0.850±0.135 g/cm2 respectively. Osteoporosis and low BMD were found in respectively 50% and 34.28%. The median probability of major osteoporotic fracture for our population was 1.5% with an interquartile range from 0.9 to 2.5% without using VFA data and 1.65% with an interquartile range from 1 to 2.6% while taking into consideration VFA results and the difference was statistically significant (p<0.0001). The median probability of hip fracture for our population was 0.4% with an interquartile range from 0.1 to 0.9% without using VFA data and 0.4% with an interquartile range from 0.1 to 1% while taking into consideration VFA results and the difference was statistically significant (p<0.0001). In all patients, the FRAX® was under the threshold intervention even after including the asymptomatic VF and it did not change the therapeutic decision. The presence of asymptomatic VF on VFA changed the therapeutic decision in 15% and indicated an anti-osteoporosis drug therapy.Conclusion:VFA scanning helped in the therapeutic decision in 15% of our population. In this evaluation, we showed that a comprehensive fracture risk pathway incorporating VFA has enhanced diagnosis of vertebral fractures and improved targeting of treatment better than FRAX® tool.Disclosure of Interests:None declared.

Hypercalcemia in a Patient Treated With Abaloparatide

Introduction: The antifracture efficacy of newer agents like PTHrP analogues is promising but knowledge about the mechanism of action and safety profile is needed in order to use these agents effectively. The reported incidence of hypercalcemia defined as albumin-adjusted serum calcium ≥10.7mg/dL was 3.4% in Abaloparitide. Case Presentation: A 59 year-old female with past medical history significant for diabetes mellitus type 2, hypothyroidism, necrotizing autoimmune myositis, osteoporosis and renal stones presented with complaints of generalized body aches and pains with swelling and redness of the left leg. The patient was diagnosed with osteoporosis based on atraumatic L4 compressive injury involving superior end plate. Her only DXA scan was 8 years ago which showed osteopenia, with the lowest T score of -1.2 at lumbar spine. Subsequent evaluation with DXA scan was unable to be performed due to physical disabilities. She was intolerant to oral bisphosphonates and was started on abaloparatide subcutaneous injections 2 weeks prior to her current admission. Her physical examination was positive for obesity, proximal muscle weakness and bilateral leg edema with bruises and left leg erythema. Laboratory findings showed hypercalcemia with corrected calcium levels of 12.48 mg/dl, suppressed intact PTH 4 pg/ml. Evaluations for secondary causes of hypercalcemia were negative. Her last dose of abaloparatide injection was the morning prior to her presentation to the emergency room. The patient was treated with IV fluids and her calcium level improved within 24 hours with normalization of intact PTH level in 72hrs. Abaloparatide injection was suspended on admission. Hypercalcemia with suppressed PTH was most likely secondary to abaloparatide given the timing of the hypercalcemia after the injection and resolution of hypercalcemia and normalization of PTH. Conclusions: Abaloparatide is a peptide that selectively binds to the RG conformation of the parathyroid hormone type 1 receptor. Abaloparatide is increasingly used following the results from the ACTIVE and ACTIVExtend trials which demonstrate significant increase in bone mineral density and risk reduction of vertebral, nonvertebral, clinical, and major osteoporotic fractures. Hypercalcemia was reported as a side effect, but there is no guidance on further evaluation or management of these patients. The incidence of hypercalcemia defined as albumin-adjusted serum calcium ≥10.7mg/dL is 3.4 % and risk is increased in patients with renal impairment. As in our case, transient hypercalcemia and PTH suppression may be associated with abaloparatide. Efficacy of abaloparatide and impact on bone density with delay or interrupted treatment are not available. Further studies are needed to guide monitoring and treatment of clinically symptomatic transient hypercalcemia in patients taking abaloparatide.

Effect of Statin Use on the Risk of Osteoporotic Fracture in Patients With Metabolic Syndrome: A Nested Case-Control Study

Statins may have advantageous pleiotropic effects on bone metabolism, however, the clinical evidence about the association is still unclear. Although many studies have already evaluated this association, they have performed mostly in a general population with limitation of between-study heterogeneity. Statin may not be equally effective for bone metabolism to every patient, but it can give some benefits for some patients especially with metabolic syndrome (MetS). However, no recent study assessing this relationship, to best our knowledge, has evaluated specifically on patients with MetS. It is also unclear whether the association between statin and osteoporotic fracture differ by statin intensity, dose (cumulative defined daily dose), and duration. This study aimed to investigate the association of statin use with the risk of major osteoporotic fracture in MetS patients from a population-based cohort (NHIS-HEALS, 2002–2015). A nested case-control study was performed in patients with MetS (≥50 years) who had no history of previous osteoporotic fracture. This study included 17,041 cases diagnosed as new-onset osteoporotic fractures and controls matched in a 1:1 ratio by age, sex, body mass index, cohort entry date, and follow-up duration. Conditional logistic regression analysis was used to evaluate covariate-adjusted odds ratio (OR) and 95% confidence interval (CI). During the 4-year follow up period, statin users had a significantly lower risk of major osteoporotic fractures by 9% (OR, 0.91; 95% CI, 0.85 to 0.97) compared with non-users. Among subtypes of major osteoporotic fracture, a risk reduction of vertebral fracture was significant (OR, 0.86; 95% CI, 0.79 to 0.94), but not non-vertebral fracture (OR, 0.97; 95% CI, 0.88 to 1.06) with statin use. Longer duration (OR, 0.97 per 1 year) and cumulative dose (OR, 0.97 per 365 defined daily dose) of statin was negatively associated with the risk of major osteoporotic fracture. There was no difference in risk of major osteoporotic fractures among groups according to statin intensity. In conclusion, this study supports the hypothesis that statin treatment has a beneficial effect on major osteoporotic fracture, especially for vertebral fracture, in patients with MetS with a possibly dose-effect relationship.