BackgroundProton pump inhibitors (PPI) are widespread nowadays. Recent concerns have emerged about possible bone complications of long-term use of PPIs, such as low bone mineral density (BMD) and an increased risk of fractures.ObjectivesThe aim of our study was to evaluate the effect of long-term use of PPIs on bone by measuring the BMD in order to estimate the frequency of osteopenia and osteoporosis, and to determine the risk factors associated to this complication.MethodsIt was a prospective study including consecutive patients who where taking proton pump inhibitors for at least one year. In all patients we realized a bone densitometry in order to evaluate the bone strength and we calculated the FRAX score to estimate the risk of osteoporotic fracture at ten years.ResultsWe included 52 patients. The mean age was 49,5 years old. The male-female ratio M/F was 0,48. At least three risk factors were found in more than 50% of the population. The calculated daily calcium intake was insufficient in 94% of the patients. The mean duration of PPIs intake was 45 months. The most frequent indication was gastro esophageal reflux disease (75%). The PPI prescription was appropriate in 94% of the cases. The prevalence of osteopenia and osteoporosis was respectively 52% and 19%. The predictive factors of low BMD were an age ≥50 years old (p=0,03), the menopause (p<0,0001), a calcium intake ≤550 mg/day (p<0,038), and a PPI use duration ≥30 months (p<0,006). The multivariate study could not be undertaken because of co linearity of the factors.ConclusionsThe long term PPI use is associated to the risk of bone complications, especially among patients at risk for osteoporosis. It seems reasonable to be more vigilant in prescribing PPIs and use lowest effective dose for patients with appropriate indications, and to screen these complications if necessary.Disclosure of InterestNone declared

Introduction elderly frequently present a poly-pathology recurring polypharmacy. Therefore, strict medication adherence is essential to avoid poor health outcomes especially during health crises like the current COVID-19 pandemic. The aims of our study were to identify the predictors of medication non-adherence in elderly and to expose the role of the emergency department (ED) to improve the therapeutic adherence during COVID-19 pandemic. Methods it was a two steps study. Primary, an observational, prospective survey over one month, including 100 elderly patients consulting to the emergency department. Medication adherence was assessed by Morisky's 4-questions scale; predictors of non-adherence have been identified. Secondary, a report of elderly medication management by the emergency physicians during the COVID-19 pandemic confinement. Results first step: 100 patients, mean age of 73±8 years. The average number of drugs was 4±2. Medication non-adherence was reported in 39%, predictors of therapeutic non-adherence were: polypharmacy (OR=2.41; CI95% [1.60;3.61]), rural origin (OR=6.72; CI95% [1.47;30.63]) and metabolic diseases history (OR=5.24; CI95% [1.48;18.53]). In the second step, 816 elder lies were enrolled, mean age: 73±7 years. The therapeutic attitude in the emergency department was to prescribe the same treatment (60%) to adjust the doses of the drugs prescribed (14%) to stop one or more drugs (13%) or to indicate new treatments (13%). Thirty-five percent of patients were admitted for short-term hospitalization. Conclusion medication non-adherence is common in elderly, due to several factors. During the COVID-19 pandemic, the emergency services in Tunisia played an important role in the follow-up and therapeutic continuity of these elderly patients.

BackgroundBone loss in autoimmune hepatitis (AIH) is scanty and conflicting. The pathogenic mechanisms are not completely elucidated.ObjectivesThis study aimed to assess the prevalence and risk factors for bone loss in patients with AIH.MethodsBone mineral density (BMD) using X-ray absorptiometry at both lumbar spine and femoral neck sites was measured in patients with AIH. Were excluded patients with diseases disturbing the bone density. Osteopenia was considered if T-score <-1.5 DS and osteoporosis if T-score <-2.5 DS.ResultsTwenty eight patients were enrolled in the study. They were 19 women (sex-ration M/F=0.6), with a mean age of 54 years [extremes: 13 - 73 years]. Most patients had type 1 AIH (89.2%). Seventeen patients were diagnosed at stage of cirrhosis (60.7%). Associated auto-immune manifestations were observed in 42.8% of cases. Overlap syndrome with primary biliary cirrhosis was noted in 21.4% of cases. Fifty five percent of patients were on steroid treatment with or without azathioprine. BMD was low in 9 patients (32%) as fellow: osteopenia in 6 cases and osteoporosis in 3 cases. There was a correlation between bone loss and use of steroid treatment but it wasn't statistically significant (p=0.07).ConclusionsIn our series, the prevalence of bone loss in AIH is high (45%). This data suggests that bone status should be assessed routinely in patients with AIH, especially in those on steroid treatment.Disclosure of InterestNone declared