Prediction of absolute risk of fragility fracture at 10 years in a Spanish population: validation of the WHO FRAX ™ tool in Spain

<p>Abstract</p> <p>Background</p> <p>Age-related bone loss is asymptomatic, and the morbidity of osteoporosis is secondary to the fractures that occur. Common sites of fracture include the spine, hip, forearm and proximal humerus. Fractures at the hip incur the greatest morbidity and mortality and give rise to the highest direct costs for health services. Their incidence increases exponentially with age.</p> <p>Independently changes in population demography, the age - and sex- specific incidence of osteoporotic fractures appears to be increasing in developing and developed countries. This could mean more than double the expected burden of osteoporotic fractures in the next 50 years.</p> <p>Methods/Design</p> <p>To assess the predictive power of the WHO FRAX™ tool to identify the subjects with the highest absolute risk of fragility fracture at 10 years in a Spanish population, a predictive validation study of the tool will be carried out. For this purpose, the participants recruited by 1999 will be assessed. These were referred to scan-DXA Department from primary healthcare centres, non hospital and hospital consultations. Study population: Patients attended in the national health services integrated into a FRIDEX cohort with at least one Dual-energy X-ray absorptiometry (DXA) measurement and one extensive questionnaire related to fracture risk factors. Measurements: At baseline bone mineral density measurement using DXA, clinical fracture risk factors questionnaire, dietary calcium intake assessment, history of previous fractures, and related drugs. Follow up by telephone interview to know fragility fractures in the 10 years with verification in electronic medical records and also to know the number of falls in the last year. The absolute risk of fracture will be estimated using the FRAX™ tool from the official web site.</p> <p>Discussion</p> <p>Since more than 10 years ago numerous publications have recognised the importance of other risk factors for new osteoporotic fractures in addition to low BMD. The extension of a method for calculating the risk (probability) of fractures using the FRAX™ tool is foreseeable in Spain and this would justify a study such as this to allow the necessary adjustments in calibration of the parameters included in the logarithmic formula constituted by FRAX™.</p

AB0384 IMPACT OF TEMPORAL ARTERY ULTRASOUND ON SURVIVAL OF PATIENTS WITH GIANT CELL ARTERITIS

Background:Giant cell arteritis (GCA) is the most common primary systemic vasculitis in adults over 50 years of age. Its incidence increases with age, with a peak between 70-80 years and predominates in women, 3:1. It is a medical emergency that, if not diagnosed, can lead to irreversible complications. The delay in time from diagnosis to start of treatment is crucial to avoid possible serious outcomes on short, medium and long term. Survival in GCA is estimated between 60-90% at 5 years and 48-81% at 10 years. Efforts have been made to implement rapid diagnostic circuits to assess patients and initiate treatment without delay with good results both in reducing permanent vision loss and in reducing the costs of these patients due to emergency visits and admissions. The morbidity and mortality of this disease is high, but the use of efficient diagnostic strategies, such as ultrasound of superficial temporal arteries, has proven to be a useful, practical, cost-effective and, above all, quick tool to make the diagnostic approach.Objectives:Analyze the impact of early temporal artery ultrasound on survival for patients with GCA.Methods:Survival study of 48 patients with GCA, in two different “stages” in terms of diagnostic approach: Group A (n = 27), patients diagnosed between 2002 - 2011 using only ACR 1990 criteria and Group E (n = 21) diagnosed between 2010-2015 using ACR criteria and TAUS. TAUS was performed by Rheumatologists with extensive experience in ultrasound and within a period of no more than 7 days for these patients. The definitive diagnosis of GCA was based on the clinical criteria of the Rheumatologist within the clinical and analytical context and with the specific complementary examinations for each case (Ultrasound, PET-CT, biopsy). Demographic data, comorbidities, signs and symptoms at debut, analytical data, complementary examinations, treatment and evolution were obtained retrospectively through the electronic medical record of the patient, based on the database of our GCA cohort. A survival analysis was performed considering death as the main outcome. The statistic used was the Kaplan-Meier test. In addition, other complications related to treatment or pathology are collected.Results:The mean age at diagnosis of our patients was 79 + - 6 years, with a female: male ratio of 3: 1. The follow-up was between 2 and 16 years with a mean of 5.8 + - 3 years, until the last visit collected or until the outcome of death. Group A had a survival at 5 and 10 years of 53.4% and 36.7% respectively, while group E of 79.5% at both cut-off points. (Figure 1).There is a significant difference between the survival of both groups, p &lt;0.01, this being better in the group in which TAUS was implemented for rapid diagnosis (group E). The main causes of death were cardiovascular events, 30%, predominantly in group E (75%), and infection, 30%, predominantly in group A. The median from diagnosis to death was 3 years (range 1 - 13).Figure 1.Group A (red line) according to ACG 1990 criteria and Group B (green line) according to ACG criteria and implementing TAUS for rapid diagnosisConclusion:The implementation of temporal artery ultrasound (TAUS) is associated with a significant improvement in the survival rate of patients with GCA and a reduction in treatment-related complications in patients who were diagnosed with ultrasound in less than 7 days compared to those diagnosed by the conventional healthcare attention routes.References:[1]Gonzalez-Gay MA, et al. Giant cell arteritis: epidemiology, diagnosis, and management. DOI: 10.1007/s11926-010-0135-9[2]Patil P, et al. Fast track pathway reduces sight loss in giant cell arteritis: results of a longitudinal observational cohort study. PMID: 26016758[3]Breuer GS, et al. Survival of patients with giant cell arteritis: a controversial issue. PMID: 31969222[4]Diamantopoulos AP, et al. The fast-track ultrasound clinic for early diagnosis of giant cell arteritis significantly reduces permanent visual impairment: towards a more effective strategy to improve clinical outcome in giant cell arteritis? 10.1093/rheumatology/kev289Disclosure of Interests:None declared</jats:sec

AB1124 IMPACT OF COVID-19 ON PATIENTS WITH RHEUMATIC DISEASES IN A SECOND LEVEL HOSPITAL

BackgroundCovid-19 has generated a change in society and in people’s daily lives. Patients with rheumatic diseases have suffered physically and mentally, both due to mobility restrictions and to the impact on personal, family, work and social life that COVID-19 has brought [1-4].ObjectivesTo examine the impact of the pandemic COVID-19 on patients with rheumatic diseases.MethodsCross-sectional descriptive study in patients with rheumatic diseases. Data collection was done through an online questionnaire to assess the impact of COVID-19, adapted for this purpose and made up of 5 scales of the 9 of the Coronavirus Psychological Impact Questionnaire [3]. This instrument is divided into two parts: 1) sociodemographic variables and 2) Experience with Coronavirus(ECOVI); Preventive Behaviour Use(UCP); Fear against coronavirus Scale(EMC); Interference with the coronavirus Scale(EIC) and positive psychological aspects(EEPA).This questionnaire was accessed through a QR code (provided to all patients both in consultations and in the day hospital) by the rheumatology team for two weeks between November-December 2021. In addition, this code was sent by the nurse via WhatsApp to all patients registered in our database. Statistical analysis: SPSS 24.0 and Pearson Chi-square, T-Student and ANOVA tests.Resultsn=362 online surveys; 72% women with a mean age of 63 years ± 14.21 (22-70 years). The most frequent rheumatic diseases were Rheumatoid Arthritis (50%) and Spondyloarthritis (31%). 83.2% had only one rheumatic disease (mean 1.26 ± 0.66) and 90% self-completed survey.In experience with the Coronavirus (ECOVI), 89% patients had not had symptoms or confirmed diagnosis of coronavirus, 98% were not hospitalized, 91% had confidence in our health system; Regarding the Use of Preventive Behaviors (UCP), 98% used a mask outside the house and 78.5% kept a safe distance; In relation to the most common fears associated with the Coronavirus (EMC), 40% were a little afraid of getting infected (34% quite a bit) and 50% were almost nothing afraid of losing their job; Regarding the interference that the coronavirus has caused in these patients (EIC), 73% had not had serious work problems and 74% had not had difficulties in their studies.In reference to the positive psychological aspects (EEPA), 48% had discovered new hobbies, 19% had become more religious,83% had learned to value personal relationships more.It was significant that women were more afraid of infecting themselves or a loved one or family member and/or dying from coronavirus than men (p=0.02; p=0.011 and p=0.002 respectively). Regarding age, younger patients (45y) were more concerned that they could lose their job compared to older patients (61y), p=0.ConclusionThe COVID-19 disease has impacted patients with rheumatic diseases. In our sample, women have been more concerned about being infected and dying themselves and their closest relatives/friends, and younger people more concerned about job loss and economic income than older people. It has to be considered that the majority of this population has not been hospitalized or diagnosed with COVID-19 and also has great confidence in our health care system. More studies are necessary to examine the impact of the COVID-19 after the 6th wave of the pandemic.References[1]Mancuso CA et al. Rheumatic Disease-Related Symptoms During the Height of the COVID-19 Pandemic. HSSJ (2020);16(1):S36-44.[2]Koppert T et al. The psychological impact of the COVID-19 pandemic on Dutch people with and without an inflammatory rheumatic disease. Rheumatology(Oxford) 2020; 12keaa842.[3]Sandín et al. Impacto psicológico de la pandemia de COVID-19: Efectos negativos y positivos en la población Española asociados al período de confinamiento nacional. J Psychopathol Clin Psychol (2020); 25(1):1-22.[4]Farrés et al. Identification of the most vulnerable populations in the psychological sphere: a cross-sectional study conducted in Catalonia during the strict lockdown imposed against the COVID-19 pandemic. BMJ Open 2021;0:e0522140.AcknowledgementsLeticia León, Milena Gobbo, Cristina Vilaplana and Day Care Unit nurses: Laura Álamo, Julia Barba, Neus Feijoo, Iolanda Bial, Neus Bardolet, Maria Soriano, Loli Arroyo, Ramon García, M Elena Casanova.Disclosure of InterestsNone declared</jats:sec

Usefulness of bone densitometry in postmenopausal women with clinically diagnosed vertebral fractures.

Objective: To analyse whether bone mineral density (BMD) assessment is required in postmenopausal women presenting with low trauma vertebral fracture. Methods: Women with vertebral fracture diagnosed over a 10 year period were recruited from our database. The following were excluded: (a) patients with high energy trauma; (b) patients with malignancies; (c) patients with a metabolic bone disease other than osteoporosis. All postmenopausal women were included in whom BMD had been evaluated at both the lumbar spine and femoral neck by dual energy x ray absorptiometry during the six months after the diagnosis. Patients with a potential cause of osteoporosis other than age and menopause were not considered. A total of 215 patients were identified. Results: The mean (SD) age of the patients was 65.9 (6.9) years. BMD at the lumbar spine was 0.725 (0.128) g/cm2 and the T score was ¿2.94 (1.22); BMD at the femoral neck was 0.598 (0.095) g/cm2 and the T score was ¿2.22 (0.89). The BMD of the patients was significantly lower than that of the general population at both the lumbar spine and femoral neck. When the lowest value of the two analysed zones was considered, six patients (3%) showed a normal BMD, 51 (23.5%) osteopenia, and 158 (73.5%) osteoporosis. The prevalence of osteoporosis at the femoral neck increased with age; it was 25% in patients under 60, 35% in patients aged 60¿70, and 60% in patients over 70. Conclusion: These results indicate that bone densitometry is not required in postmenopausal women with clinically diagnosed vertebral fractures if it is performed only to confirm the existence of a low BMD