A retrospective population-based survey was undertaken in a region of Bulgaria to determine the incidence of hip fracture. The estimated number of hip fractures nationwide for 2015 was 9322 and is predicted to increase to 11,398 in 2050. The hip fracture rates were used to create a FRAX model. Objective To describe the epidemiology of hip fractures in Bulgaria, which was then used to develop the country-specific fracture prediction FRAX® tool. Methods We carried out a retrospective population-based survey in Stara Zagora, Bulgaria, representing approximately 4.6% of the country's population. We identified hip fractures occurring in 2015, 2016 and 2017 from hospital registers and primary care sources held by the regional health insurance agency. Age-and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for Bulgaria. Fracture probabilities were compared with those from neighbouring countries having FRAX models. Results The incidence of hip fracture applied nationally suggested that the estimated number of hip fractures nationwide in persons over the age of 50 years for 2015 was 9322 and is predicted to increase to 11,398 in 2050. FRAX-based probabilities were higher in Bulgaria than those in Serbia or Romania, lower than those in Turkey and similar to those in Greece. Conclusion The FRAX model should enhance accuracy of determining fracture probability among the Bulgarian population and help guide decisions about treatment.

Background Osteoporosis is a common chronic disease characterized by low bone mineral density (BMD) and microarchitectural deterioration of the bone, which are associated with increased risk of fragility fractures. Currently the most popular tool is the fracture risk assessment model FRAX to calculate the 10-year probability of major osteoporotic fractures (MOF) and hip fractures (HF). Objective To investigate the prevalence of low BMD at axial sites and fracture risk in Bulgarian population. Methods We retrospectively analyzed dual energy X-ray absorptiometry (DXA) scan results of 12 478 subjects. Scan results included BMD and T-score assessments of lumbar spine and femoral neck. FRAX major osteoprotic fracture (MOF) and FRAX hip fracture (HF) were assessed in subjects between 40 and 90 years using BMD values. Results Of total 12478 subjects, 12119 were women and 359 were men. The mean age of the subjects was 61 years (yrs.) ± 10 yrs. The overall prevalence of low BMD at the lumbar spine was 6084/9336 subjects (65.2%). 3502/9336 subjects (37.5%) were considered as osteopenic and 2582/9336 subjects (27.7%) were considered as osteoporotic. The overall prevalence of low BMD at the femoral neck was 2036/3140 (64.8%). 1641/3140 subjects (52.3%) were classified as osteopenic and 395/3 140 subjects (12.6%) were classified as osteoporotic. The mean values of FRAX MOF and FRAX HF increased significantly with increasing the age interval. Conclusion This study is the largest epidemiological research in Bulgaria up to date about the prevalence of low BMD at axial sites.

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

BackgroundOsteoporosis is a common bone disease characterized by reduction in bone mass accompanied by microarchitectural changes, resulting in brittle bones and in an increased risk of fractures. Rheumatoid arthritis is a well-known risk factor for the development of osteoporosis. With the introduction of radiofrequency echographic multi spectrometry (REMS), easily evaluation of the lumbar spine bone mineral density (BMD) ultrasound (BMDus) and hip BMDus is possible for early diagnosis of osteoporosis.ObjectivesThe aim of this study is to compare the characteristics of the osteoporotic patients with and without rheumatoid arthritis through radiofrequency echographic multi spectrometry.MethodsA total of 70 patients with osteoporosis were included in the study. 43% of them (30/70) had RA and 57% (40/70) were without RA. Patients were diagnosed with rheumatoid arthritis if they had a score of 6/10 or higher based on 2010 ACR/EULAR classification criteria for RA. Age, body mass index (BMI), lumbar spine BMDus, as well as total hip BMDus and fracture risk score (FRAX) were assessed.ResultsPatients with RA were significantly younger (69.3 ± 6.5 years) than those without RA (76.4 ± 5.0 years) (p = 0.002). BMI values did not differ significantly between the two groups (25.76 ± 4.82 kg/m2 for patients with RA and 27.57 ± 5.37 kg/m2 for patients without RA). Patients with and without RA did not show any significantly differences between BMDus values of L1-L4 (0.629/0.607 g/cm2 for L1, 0.692/0.688 g/cm2 for L2, 0.761/0.743 g/cm2 for L3 and 0.789/0.769 g/cm2 for L4). Patients with RA had higher total lumbar spine T-score (-2.6 ± 0.8 standard deviations) compared to those without RA (-3.1 ± 0.5 standard deviations), but this difference was not significant (p > 0.05). Femoral neck BMDus, trochanteric BMDus and total hip BMDus were similar in the groups with and without RA (0.550/0.548 g/cm2 for femoral neck, 0.710/0.693 g/cm2 for trochanter, 0.688/0.678 g/cm2 for total hip). FRAX score of the patients with RA was significantly higher (32.89% for 10-year probability of major osteoporotic fracture and 14.29% for 10-year probability of hip fracture) compared to the patients without RA (22.36% for 10-year probability of major osteoporotic fracture and 8.75% 10-year probability of hip fracture).ConclusionAlthough there were no significant differences in lumbar spine BMDus values and total hip BMDus values between the patients with and without RA, patients with RA showed higher 10-year probability of major osteoporotic fracture and hip fracture.References[1] Conversano F, Franchini R, Greco A, Soloperto G, Chiriacò F, Casciaro E, Aventaggiato M, Renna MD, Pisani P, Di Paola M, Grimaldi A, Quarta L, Quarta E, Muratore M, Laugier P, Casciaro S (2015) A novel ultrasound methodology for estimating spine mineral density. Ultrasound Med Biol41:281–300[2] Casciaro S, Peccarisi M, Pisani P, Franchini R, Greco A, De Marco T, Grimaldi A, Quarta L, Quarta E, Muratore M, Conversano F (2016) An advanced quantitative echosound methodology for fem...