Diagnosis of osteoporosis in COPD patients: Estimation of the 10-year probability of a major osteoporotic fracture (FRAX), and Dual-energy X-Ray Absorptiometry

The aim of the study was to evaluate various methods of osteoporosis diagnostics (FRAX® and Dual-energy Х-Ray absorptiometry – DXA) and the sequence of their application in the diagnostic algorithm in COPD patients without a history of large bone fractures. Methods. Cross-sectional study of 115 COPD patients without exacerbation (93 men and 22 women, mean age 67.2 ± 7.1 years). The study included clinical examination, FRAX® estimation and comparison of the 10-year probability of a major osteoporotic fracture (MOF) with the Russian intervention threshold, spirometry, DXA of lumbar spine and proximal femur, semi-quantitative radiographic morphometry by Genant. All patients were examined using several methods that are possible in clinical practice: 1) FRAX® without DXA; 2) FRAX® + DXA in patients with intermediate 10-year probability of MOF and recalculation of FRAX® probability including femoral neck bone mineral density (BMD); 3) FRAX® + DXA in patients with intermediate 10-year probability of MOF. Take into account DXA results; 4) DXA without FRAX® ; 5) DXA + recalculation of FRAX ® for individuals with normal BMD or osteopenia. Results. In the whole sample of patients 1 – 5 diagnostic methods revealed 5.1, 7.0, 15.7, 44.3, 45.2% of individuals with osteoporosis, respectively. In men, the methods using FRAX ® (1 – 3) gave unsatisfactory results – the number of patients requiring treatment did not exceed 4.3%, while DXA revealed osteoporosis in 43%. FRAX® + DXA analysis in patients with intermediate 10-year probability of MOF (3 th method) was the best for women. The main independent predictors of low bone mineral density were post-bronchodilator FEV 1 ≤ 30% predicted and/or long-term oral glucocorticoid use. Asymptomatic vertebral fractures were detected in 11 patients. Before the radiographic morphometry, treatment would have been prescribed only 1 patient for the 1th or 2th methods; 5 patients – 3th method and 9 patients using 4th or 5th methods. Conclusion. The use of the Russian FRAX® model in men with COPD revealed a very low percentage of people who need osteoporosis treatment; DXA was the optimal diagnostic method. If it`s not possible to perform DXA in the most COPD patients, it should be prescribed to people with very severe bronchial obstruction and/or taking long-term oral glucocorticoid therapy. Regardless of the BMD parameters, semi-quantitative X-ray morphometry should be performed to diagnose asymptomatic vertebral fractures.

A country-specific FRAX model for Botswana

Introduction Hip fracture rates in Botswana were used to create a FRAX® model for fracture risk assessment. Objective This paper describes the development and characteristics of a country-specific FRAX model for Botswana. Methods Age-specific and sex-specific incidence of hip fracture and national mortality rates was incorporated into a FRAX model for Botswana. Ten-year fracture probabilities were compared with those from African countries having a FRAX model and African Americans from the USA. Results The probabilities of hip fracture and major osteoporotic fracture were low compared with those from South Africa (Black and Coloured) and US Blacks. Probabilities were marginally higher than for Tunisia. Conclusion The creation of a FRAX model is expected to help guide decisions about the prevention and treatment of fragility fractures in Botswana.

POS0164 THE NEED FOR ANTI-OSTEOPOROTIC INTERVENTION IN POSTMENOPAUSAL WOMEN WITH RHEUMATOID ARTHRITIS BASED ON THE FRACTURE RISK ASSESSMENT

Background:Rheumatoid arthritis (RA) is a chronic disabling disease that is associated with bone loss. Previous studies estimated that approximately one-third of the RA patients had osteoporosis (OP). However, most fragility fractures occur in patients not suffering from OP, that can be partly explained by impaired quality of bone, which is not measured with DXA. Therefore, only the measurement of bone mineral density is not sufficient to determine the indication for OP treatment. Another tool for assessing the need for anti-osteoporotic therapy is to calculate the 10-year probability of a major fracture using the fracture risk assessment tool (FRAX).Objectives:To assess the need for anti-osteoporotic therapy in women with rheumatoid arthritis (RA) based on the identification of individuals with fragility fractures and high risk of fracture according to FRAX.Methods:295 postmenopausal women with RA were included in the study. The average age was 63±7 years, the duration of RA was 11 [4;16] years, the duration of postmenopausal period was 13 [6; 20] years. 121 (41%) patients took glucocorticoids (cumulative dose 9025 [3650; 20720] mg in prednisolone equivalent). A survey was conducted to identify patients with risk factors and a history of fragility fractures. The 10-year probability of a major osteoporotic fracture was assessed using the FRAX tool. In patients treated with glucocorticoids at a dose >7.5 mg in prednisolone equivalent the estimates of probabilities of a major osteoporotic fracture were adjusted in accordance with the recommendations [1]. Dual-energy X-ray absorptiometry (DXA) of the proximal femur was performed in patients with a moderate risk (probabilities between the upper and lower assessment age-dependent intervention threshold) and the risk of fracture was recalculated with including femoral neck BMD.Results:83 (28.1%) patients had a prior fragility fracture: 44 (14,9%) – 1, 20 (6,8%) – 2 and 19 (6.4%) – 3 or more. Vertebral fractures were the most common, they accounted for 62,1% of all fractures, distal forearm was the second frequent fractures localization (18.2%). Only 2 (0.7%) women had hip fracture. The average 10-year probability of a major osteoporotic fracture was 17 % [11; 28] in RA women. 92 (31.2%) persons were at high risk, 28 (9.5%) patients - at low risk, and 175 (59.3%) - at moderate risk. After recalculation of fracture risk with including femoral neck BMD in people at moderate risk 48 (16.3 %) patients became at high risk, 9 (3.1%) – at very high risk, and 118 (40.0%) - at low risk.Thus, 149 (50.5%) RA patients were at very high or high risk and 146 (49,5%) – at low risk of major osteoporotic fracture according to FRAX, among the last – only 3 persons had a history of fragility fracture after age of 40 years.Conclusion:Our study demonstrated that a half of postmenopausal women with RA had indications for anti-osteoporotic treatment based on the results of a 10-year probability of major fragility fractures using FRAX tool.References:[1]Kanis JA, Johansson H, Oden A, McCloskey EV. Guidance for the adjustment of FRAX according to the dose of glucocorticoids. Osteoporos Int. 2011;22(3):809-816. doi:10.1007/s00198-010-1524-7.Disclosure of Interests:None declared

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.

Association Between 10-Year Fracture Probability and Nonalcoholic Fatty Liver Disease With or Without Sarcopenia in Korean Men: A Nationwide Population-Based Cross-Sectional Study

ObjectiveNonalcoholic fatty liver disease (NAFLD) and sarcopenia, which are common in elderly men, are known as risk factors of fracture. However, few studies have examined the association with fracture in these patients. Therefore, we aimed to investigate the association between NAFLD with or without sarcopenia and 10-year fracture probability in Korean men aged ≥50 years.Materials and MethodsData of 2,525 individuals from the 2010–2011 Korea National Health and Nutrition Examination Survey were analyzed. NAFLD was defined using the fatty liver index (FLI) and comprehensive NAFLD score (CNS), and liver fibrosis using the fibrosis 4 calculator. Sarcopenia was defined as the lowest quintile for sex-specific sarcopenia index cutoff; values. The Fracture Risk Assessment (FRAX) tool was used to predict the 10-year probability of major osteoporotic and hip fractures.ResultsCompared to the no NAFLD group, the 10-year major osteoporotic fracture probability was significantly associated with the FLI-defined (β = 0.16, P = 0.002) and CNS-defined (β = 0.20, P < 0.001) NAFLD groups with liver fibrosis. Similarly, the 10-year hip fracture probability was significantly associated with the FLI- and CNS-defined NAFLD with liver fibrosis groups compared to the group without NAFLD (FLI-defined group, β = 0.04, P = 0.046; CNS-defined group, β = 0.05, P = 0.048). Furthermore, in the group with sarcopenia, the 10-year major osteoporotic fracture probability was significantly associated with the FLI- and CNS-defined NAFLD with liver fibrosis groups compared to the group without NAFLD (FLI-defined group, β = 0.29, P = 0.003; CNS-defined group, β = 0.38, P < 0.001).ConclusionsNAFLD with liver fibrosis is significantly associated with a higher 10-year major osteoporotic and hip fracture probability in Korean men aged ≥50 years, and this positive association was more profound in patients with sarcopenia. Therefore, screening middle-aged to elderly men who have NAFLD combined with liver fibrosis and sarcopenia may help prevent fractures.

93 Does Spinal Bone Mineral Density Predict An Absolute 10 Year Probability of Sustaining A Major Osteoporotic Fracture

Introduction Spine and hip bone mineral density (BMD) have previously been shown to predict the risk of sustaining future fractures. Although these have been shown in population studies, there is a paucity of trials looking at the relationship between BMD and 10 year probability of major osteoporotic fractures (Using FRAX UK without BMD) in patients with previous fragility fractures. Aims To evaluate the correlation between spinal T-score and an absolute 10 year probability of sustaining a major osteoporotic fracture (using FRAX without BMD) in patients with prior fragility fractures. Methods A retrospective cross-sectional analysis of 202 patients (29 males and 173 females) with prior fragility fractures attending a fracture prevention clinic between January and August 2019 was performed. Patients with pathological and high impact traumatic fractures were excluded. The BMD at the spine was determined using the lowest T-score of the vertebrae from L1 to L4. Using the FRAX (UK) without BMD, the absolute 10 year probability of sustaining a major osteoporotic fracture was calculated for each patient. Statistical analysis was performed using SPSS 26 software. Results The mean T-score at the spine was −1.15 (SD +/− 1.90) for all patients, −0.68 (SD +/− 0.45) for males and − 1.23 (SD +/− 0.14) for females. The mean FRAX score without BMD for major osteoporotic fracture was 18.5% (SD +/− 8.84) for all patients, 11.41% (SD +/−0.62) and 19.7% (SD +/−0.68) for males and females respectively. Pearson correlation coefficient showed a statistically significant, slightly negative correlation between spinal T- score and the FRAX (UK) without BMD (r = −0.157; p < 0.05). Correlation was not statistically significant when males (r = 0.109; p = 0.59) and females (r = 0.148; p = 0.053) were considered independently. Conclusion In patients with prior fragility fracture spinal BMD has a statistically significant negative correlation with an absolute 10 year probability of sustaining a major osteoporotic fracture.