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One of the most common causes of lumbar scoliosis in adults is the decreased bone mineral density (BMD). The scoliosis in the lumbar spine has a known effect over the dual-energy X-ray absorptiometry (DXA) scan results. The objective of this study is to assess the influence of the lumbar scoliosis on the results of the DXA scan of the lumbar spine. 1019 women aged ≥40 years underwent a DXA scan of the spine. Age, weight, height, total BMD, total Tscore of the lumbar spine were recorded. The angle of the lumbar scoliosis (Cobb’s angle) was measured from the DXA scan image using a DICOM software. The incidence of lumbar scoliosis in the current study accounts to 12.3%. Women with scoliosis showed significantly higher incidence of discrepancy in BMD T-scores between the adjacent vertebrae by more than 1 SD compared to women without scoliosis, (p=0.046). DXA results of subjects with scoliosis require more detailed evaluation of the T-scores of each vertebra to make a prompt decision about the final diagnosis.

Background:Osteoporosis is known to be a risk factor for fragility fractures [4, 5]. On one hand, vertebral body fragility fractures often lead to additional spine deformity [2]. On the other hand, it was found that with the progression of the spinal curvature in osteoporotic patients, the fragility fractures develop more frequently. The increased incidence of these fractures could be explained with a predominance of the mechanical forces on the one side of the already weakened osteoporotic vertebrae [3].Objectives:The aim of this study is to compare the fracture risk (FRAX) for major osteoporotic fractures (MOF) and for hip fractures (HF) in women with and without scoliosis through dual-energy X-ray absorptiomentry (DXA)Methods:In the current study, 59 women underwent DXA scans. Scoliosis was defined as Cobb’s angle ≥ 5◦ according to the Chaklin’s classification [6, 7]. Cobb’s angle was measured from DXA images with DICOM software. We evaluated the following risk factors: previous fractures, parental hip fractures, secondary osteoporosis, rheumatoid arthritis, use of corticosteroids, current smoking and alcohol consumption more than 3 units daily. We estimated FRAX MOF and FRAX HF on the basis of these risk factors and on the basis of the femoral neck bone mineral density (BMD). The calculations were done through FRAX tool published on the website of the University of Sheffield [1].Results:The mean age of the women was 63 years (yrs.) ± 10 yrs. (range 43 yrs. – 89 yrs.). Subjects with scoliosis were significantly older (67 yrs.) than those without scoliosis (59 yrs.), (p = 0.004). Mean weight and height didn’t differ between the groups with- and without scoliosis. Mean lumbar spine BMD and T-score differed significantly between the groups, (p = 0.02). Women with scoliosis had lower mean BMD (0.786 g/cm2) and lower mean T-score (-2.1 standard deviations (SDs)) compared to those without scoliosis (mean BMD: 0.912 g/cm2 and mean T-score: 0.9 SDs). The mean FRAX MOF (19.3%) and FRAX HF (5.9%) of the subjects with scoliosis were significantly higher than those of the women without scoliosis (FRAX MOF: 14.9% and FRAX HF: 3.1%), (p = 0.004 for FRAX MOF and p = 0.010 for FRAX HF).Conclusion:Women with scoliosis showed significantly higher fracture risk for major osteoporotic fractures and for hip fractures compared to those without scoliosis.References:[1]https://www.sheffield.ac.uk/FRAX/index.aspx[2]Mao YF, Zhang Y, Li K, et al. Discrimination of vertebral fragility fracture with lumbar spine bone mineral density measured by quantitative computed tomography. J Orthop Translat. 2018;16:33–39. Published 2018 Oct 10. doi:10.1016/j.jot.2018.08.007.[3]Sabo A, Hatgis J, Granville M, Jacobson RE. Multilevel Contiguous Osteoporotic Lumbar Compression Fractures: The Relationship of Scoliosis to the Development of Cascading Fractures. Cureus. 2017;9(12):e1962. Published 2017 Dec 19. doi:10.7759/cureus.1962.[4]Kirilova E, Cherkezov D, Gonchev B, Zheleva Z. OSIRIS Index for the assessment of the risk for osteoporosis in menopausal women, National conference with international participation, 6-7 october 2019, Kardzhali “Science and society 2019”, RKR print OOD ISSN 1314-3425[5]Madzharova R, Kirilova E, Petranova T, Nikolova M. Assessment of the activity for self care in women with osteoporosis, Science and TechnologieVolume VIII, 2018, Number 1: MEDICAL BIOLOGY STUDIES, CLINICAL STUDIES, SOCIAL MEDICINE AND HEALTH CARE,1-6.[6]Chaklin VD, Orthopedy - Moscow: Medgiz – 1965 – C. 209[7]Chaklin VD. Pathology, clinical manifestation and treatment of the scoliosis, 1stcongress of the union of the orthopedists and traumatologists, Moscow: Medgiz, 1957 – T.2. – p 798Disclosure of Interests:None declared

BackgroundIn 1989 Gleicher and co-authors describe for the first time the so called reproductive autoimmune failure syndrome (RAFS) in women with infertility, endometriosis and high levels of autoantibodies. The complex interrelations between autoimmune diseases and reproductive processes are still investigated. In the context of assisted reproductive technologies there is a discussion about the induction of autoimmune disorders in relation with the hormonal therapy and the ovarian hyperstimulation, especially in the presence of genetic predisposition.MethodsCase Report: A 30-year-old woman was operated in relation with Polycystic Ovary Syndrome (Stein–Leventhal syndrome). Subsequently due to impossibility for conception, 10 unsuccessful attempts of intrauterine insemination were conducted. In 2009 in accordance with the respective protocol an attempt for in vitro fertilization was made, again unsuccessful. In the progress of the assisted reproduction, hormonal preparations were applied. The patient developed arthralgias of the small joints of the hands and began self-treatment with non-steroid anti-inflammatory drugs. The mother of the patient has rheumatoid polyarthritis associated with Sjögren and Raynaud syndromes.Before the commencement of a new reproductive cycle, the young woman was immunologically analized. The presence of anti-nuclear antibodies (ANA-dsDNA) was discovered. The results of the other immunological tests were in the reference ranges.After the discontinuation of the hormonal drugs, the articular manifestations faded away and the immunological indicators returned to normal.The results of the immunogenotyping of the patient and her mother (using DNA-PCR-SSP) revealed carriage of HLA-A*01, B*08, Cw*07, DRB1*03, DQB1*02 haplotype in both.In 2013 after a new attempt for in vitro fertilization and hormonal therapy, the patient developed symmetrical arthritis of the small joints of the hands, positive anti-CCP antibodies and rentgenological erosive changes of the affected joints. (Registered after a 10 month self-treatment with non-steroid anti-inflammatory and analgesic drugs.)ConclusionsDiscussion: The presented case demonstrates a strong predisposition towards autoimmune diseases, associated with the carriage of the pointed out haplotype: HLA-A*01, B*08, Cw*07, DRB1*03, DQB1*02. In the case of the mother there are clinical manifestations of autoimmune rheumatic diseases – rheumatoid arthritis, Sjögren and Raynaud syndromes. Meanwhile in the young woman the autoimmune disease is initially disguised by the presence of ANA and infertility. During a subsequent attempt for in vitro fertilization and hormonal therapy, the patient develops seropositive rheumatoid arthritis.Disclosure of InterestNone declared

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