BackgroundPolymyalgia Rheumatica (PMR) is usually treated with steroids, but long-term usage is detrimental to bone health. It is not uncommon for corticosteroid treatment to last for longer than a year [1]. No study has looked at the differential effect of steroids on either gender in this group of patients.ObjectivesTo examine the effect of steroids on bone health in patients with PMR by gender.MethodsPatients with PMR referred for BMD (Bone Mineral Density) estimation in a district hospital in the northwest of England between 2004 and 2011 were examined. Patients’ demographics were recorded and Bone mineral density (BMD) were measured in both hips as well as the lumbar spine. Frax(TM) Risk factors (RF’s) for osteoporosis were also ascertained at the time of DEXA.Initially RF’s were compared between men and women using a students’ T test for continuous variables and chi squared test for categorical variables. A logistic model was then fitted to compare RF’s for fracture between men and women. Lastly a stepwise multivariate model was fitted using STATA (tm) version 12.Results1051 patients with PMR were referred in the study period, mean age was 81.74 years (SD 9.58). 764 (84.7%) were females. Fractures were sustained in 26.3 % overall and there was a significant difference in males and females. Females were 2.58 times higher odds to sustain a fracture (CI 1.79 - 3.70).Using univariate logistic regression, the RF’s for fracture in men were a reduced lumbar spine BMD (OR.794, CI.657 to.959) and a reduced left femur total BMD (OR.748, CI.568 -.984). In women the RF’s were increasing age (OR 1.04, CI 1.020 to 1.055), reduced lumbar spine BMD (OR.841, CI.764 -.926), reduced right femur total BMD (OR.738, CI.644 -.845), reduced left femur total BMD (OR.706, CI.615 -.810) and current steroid therapy (OR.573, CI.369 -.889).In the multivariate model the RF’s in men were a diagnosis of coeliac disease (OR 17.38, CI 1.746 - 173.03), and a reduced left femur total BMD (.783, CI.588 - 1.042). In women the RF’s were increased age at scan (OR 1.025, CI 1.004 - 1.047), history of fracture (OR 1.891, CI 1.104 - 3.238), reduced left femur total BMD (.720, CI.611 -.849) and reduced BMI (OR 1.035, CI 1.002 - 1.068).Characteristics are shown in Table 1 below.ConclusionMen and women with PMR differ in their bone health, firstly in their demographics and secondly in their fracture risk with men who malabsorb having the highest fracture risk. This is the first intimation that fracture risk could be different. Limitations included not knowing the steroids’ duration before scanning and only using first scan data. Strengths include the large number of subjects. Longitudinal data the collection of which is ongoing will provide further clarity.Reference[1]NICE CKS. CKS is only available in the UK [Internet]. NICE. 2021. Available from:https://cks.nice.org.uk/topics/polymyalgia-rheumatica/Table 1.CharacteristicMalesFemalesStudy287764Age, Years, mean, (SD)81.79 (9.34)81.72 (9.68)P = 0.9174Weight, KG, (mean (SD)82.08 (12.78)71.98 (15.91)P = < 0.000Height (SD)172.74 (6.62)158.69 (7.07)P = < 0.000BMI (SD)27.50 (3.98)28.74 (9.26)P = 0.0278Fracture n (%) of those in study42 (14.63%)234 (30.63%)P = <0.000Smoker current N (%)21 (7.32 %)59 (7.72%)P =.825Current Excess Alcohol Use %27 (9.4%)23 (3.01%)P = < 0.000BMD Left Femur Total-.499 (279)-.917 (718)P = <0.000BMD Right Femur Total-.518 (271)-.930 (705)P = <0.000BMD lumbar spine (mean).377 (287)-.782 (762)P = <0.000Current steroid use %256 (89.1%)658 (87.4%)P =.434Disclosure of interestNone declared.Disclosure of InterestsNone Declared.

Objectives The standard treatment for giant cell arteritis (GCA) are high dose glucocorticoids (GC). It is unknown whether GC are more detrimental to bone mineral density (BMD) at the spine or the hip. The aim of this study was to investigate the effect of GC on BMD at the lumbar spine and hip in patients with GCA being treated with GC. Methods Patients who were referred for a dual-energy X-ray absorptiometry (DXA) at a hospital in the North-West of England between 2010 and 2019 were included. Two patient groups were identified, patients with GCA on current GC (cases) matched 1:4 based on age and gender to those referred to the scanner with no indication for scanning (controls). Logistic models were fitted looking at the spine and hip BMD unadjusted and adjusted for height and weight. Results As would be expected, this gave an adjusted odds ratio (OR) of 0.280 (95%CI 0.071; 1.110) at lumbar spine, OR of 0.238 (95%CI 0.033; 1.719) at left femoral neck, OR of 0.187 (95%CI 0.037; 0.948) at right femoral neck, OR of 0.005 (95%CI 0.001; 0.021) of left total hip and OR of 0.003 (95%CI 0.001; 0.015) at right total hip. Conclusion The study has shown patients diagnosed with GCA receiving GC treatment have a lower BMD at the right femoral neck, left total hip and right total hip compared with the controls in patients of the same age and gender after adjusting for height and weight. Lay summary What does this mean for patients ? Giant cell arteritis (GCA) is the most common type of inflammation affecting medium and large vessels. Glucocorticoids (GC) are the main treatment for GCA and are helpful in preventing serious eye complications including blindness. Studies have shown various results of GC treatment in patients diagnosed with GCA causing a decrease in bone mineral density (BMD). The aim of our study was to assess whether GC use in patients diagnosed with GCA causes a decrease in BMD and if so, is it worse in the spine or the hip. Our study showed that patients with the same age and sex diagnosed with GCA using GC have a lower BMD than controls at the right femoral neck, left total hip and right total hip, after adjusting for height and weight. This suggests that overall GC is associated with lower hip BMD. These findings are important to clinicians as it gives guidance surrounding bone protection in patients with GCA using GC. These results can also be useful for future research to investigate the incidence of fractures in patients diagnosed with GCA taking GC. The results of this study along with any future research can help improve management and long term outlook in patients.

BackgroundThe FRAX™ risk assessment tool is utilised to predict fracture risk in patients with poor bone health. It uses the bone mineral density (BMD) at the non-dominant femoral neck. The performance of the tool in predicting fractures with worsening BMD has not been examined.ObjectivesThe aim of this study was to investigate whether different factors within the FRAX™ tool are more predictive of severe osteoporosis; defined by a T score of -3.5 and below, compared to patients with a t score of -2.5 to -3.49.MethodsTwo patient cohorts were identified from patients referred for routine DEXA scans between 2004 and 2019, in the Northwest of England. The first cohort (group A) consisted of patients with a T score between -2.5 and -3.5 and the second cohort (group B) consisted of patients with a T score of -3.5 and below. The FRAX risk factors and the BMD data were analysed, using a Student’s T test for continuous variables and a Chi Squared test for categorical variables. Univariate and multivariate logistic regression models were also fitted examining the differences in the FRAX™ risk factors and severe osteoporosis prediction. The sites measured included an average of L1-L4, right and left femoral neck in which their BMD mean and both their respective BMD totals were analysed. FRAX™ risk factors included age, weight, height, BMI, sex, previous fracture, parent fractured hip, smoking, steroid use, rheumatoid arthritis, alcohol consumption and coeliac disease/malabsorption.Results31,547 patients were included in the analysis, with a mean age of 64.9 years (SD = 12.9). The number of individuals in group A were 4,714 (81.54%) and 1,067 (18.46%) in group B. Table one depicts the differences in the FRAX™ risk factors between the two groups and the odds ratios. Age, weight, height, BMI and current smoking were statistically significant in predicting severe osteoporosis. Lower weight, height and BMI was associated with group B. In addition, increased age and current smoking was also associated with group B. There was no significant difference between group A and B in regard to sex, previous fracture, parent fractured hip, steroid use, rheumatoid arthritis, alcohol consumption or coeliac disease/malabsorption.ConclusionThe results of this study indicate that certain risk factors used in the FRAX™ scoring are more predictive of a severe osteoporosis than others. In addition, research providing insight into utilising FRAX™ variables in fracture prediction in patients with severe osteoporosis will provide valuable insight.Table 1.The differences in the FRAX™ characteristics between group A and B, the corresponding odds ratio and confidence intervalCharacteristicGroup AGroup BOdds ratio and confidence intervalAverage age in years (SD)72.52 (10.80)75.52 (11.18)1.10*[1.02,1.04]Average weight in kilograms (SD)63.27 (13.27)55.94 (14.02)0.95*[0.95,0.96]Average height in centimetres (SD)158.96 (8.44)155.89 (10.48)0.96*[0.95,0.97]Average BMI in kg/m2(SD)25.02 (4.82)24.16 (26.62)0.91*[0.90,0.92]SexFemale - 3,844 (81.54%)Male – 870 (18.46%)Female – 854 (80.04%)Male – 213 (19.96%)1.10[0.93,1.30]Previous fracture2 (0.04%)1 (0.09%)2.21[0.20, 24.4]Parent fractured hip65 (1.38%)9 (0.84%)0.61[0.30,1.23]Current smoking1,792 (38%)445 (41.71%)1.17*[1.01,1.34]Steroids (current)1,165 (24.71%)271 (25.4%)1.04[0.89,1.21]Rheumatoid arthritis362 (7.68%)88 (8.25%)1.08[0.85,1.38]Alcohol consumption284 (6.02%)68 (6.37%)1.06[0.81,1.40]Coeliac disease/malabsorption183 (3.88%)50 (4.69%)1.22[0.88,1.67]REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Background/Aims Osteoporosis is characterised by a reduction in bone mineral density (BMD). Low BMD is correlated with increased fracture risk. It is unclear whether a BMD value at a specific site is superior for predicting fracture. The Fracture Risk Assessment (FRAX™) tool is used to evaluate fracture risk, using the BMD at the non-dominant hip; focussing on the neck mean and neck total. This is despite a T score of -2.5 or below in the lumbar spine defining a patient as osteoporotic. This study aimed to determine whether the other measures of BMD that are noted are as predictive of fracture. Methods Patients referred for routine dual-energy x-ray absorptiometry (DEXA) scans at the Royal Lancaster Infirmary from 2004 to 2019 were studied. BMD data from lumbar vertebrae (L1-L4) and anatomical regions of the left and right femur were collected from DEXA images. A logistic regression model was fitted using fracture as a dependent variable and BMD values from the lumbar vertebrae, right and left femur as predictors, adjusted for age at scan and sex. Goodness of fit was assessed using a receiver operating characteristic (ROC) curve. Results A total of 31,546 patients were included in the analysis (82.9% female), of whom 37.6% had sustained a fracture, and the mean age of the cohort was 64.9 (standard deviation 12.9). Table 1 shows the results of the logistic models. Areas under the receiver operating characteristic curve (AUC) demonstrated the positive predictive ability of a reduction in BMD in the lumbar vertebrae and regions of the femur and fracture risk. BMD data from the four lumbar vertebrae were just as predictive of fracture as the right and left femur. Conclusion The study findings demonstrate that low BMD in all areas measured were equally predictive of fracture. When the non-dominant hip is not measurable, using other areas from a DEXA scan could be used to predict fracture risk. Research evaluating change in BMD over time could alter this observation. Disclosure U. Nadeem: None. M. Bukhari: None. Z. Sultan: None.