Ab1023 characteristics of Patients Referred for First Bone Densitometry to a Rheumatology Fls, With Normal Results in the Lumbar Spine

Abstract

ObjectivesTo analyze the characteristics of postmenopausal women referred for the first bone densitometry (BMD), with normal results in the lumbar spine.MethodsRetrospective study of postmenopausal women, for a first BMD, at a rheumatology FLS, during February/2010-December/2021.General patient data (age, gender), osteoporosis (OP) risk factors were collected: age at menopause, parental hip fracture, body mass index (BMI), smoking and alcohol habit, drugs and potentially osteopenizing diseases, low-impact fractures in adulthood (fractures of osteoporotic origin included: vertebral, hip, humeral head and distal radius and pelvis), current treatment for OP and FRAX index.Results2.930 postmenopausal women with normal lumbar BMD are included: 505 (17%) had suffered an OP fracture: mean age (SD): 63.2 years (8.5) and of menopause 48 years (10). Among the OP risk factors: early menopause: 818 (28%) women, active smoking: 521 (18%), alcohol > 3 units: 84 (2%), parents hip fracture: 310 (11%). Among osteopenizing diseases: rheumatoid arthritis/chronic arthritis: 112 (4%) patients, inflammatory bowel disease: 44 (2%), arteritis/polymyalgia rheumatica: 35 (1%) and the rest <1%. Among the osteopenizing drugs: omeprazole: 967 (33%) patients, thyroxine: 354 (12%), oral or inhaled corticosteroids: 261 (9%) and aromatase inhibitors: 168 (6%).427 (15%) patients had had a previous OP fracture: distal radius: 188 (6%), vertebral: 146 (5%), humeral head: 46 (2%) and hip: 47 (2%). 808 (28%) patients were receiving treatment for OP: oral bisphosphonates: 518 (18%), SERM: 136 (5%), strontium ranelate: 75 (3%), denosumab: 51 (2%), teriparatide: 16 (0.7%) and zoledronate: 12 (0.5%) (Table 1).Table 1.Characteristics of patients with normal lumbar spine BMD.TOTAL BMD LS NormalN: 2.930Normal BMD LS WITH fractureN: 505 (17%)Normal BMD LS WITHOUT fractureN: 2.425 (83%)pAge in BMD, years, mean (SD)63,270.5 (7.78)60.6 (26)0.0001Menopausal age, years, mean (SD)48 (8.4)45 (5.46)48 (8.48)0.0001Early menopause, n (%)814 (28)171 (34)643 (27)0.07BMI, kg/m2, media (SD)29,1 (10.3)29.5 (17.03)28,9 (10.3)0.44Active tobacco, n (%)521 (18)40 (8)481 (20)0.06Alcohol ≥ 3 units, n (%)84 (2)10 (2)74 (3)0.85Parent hip fracture, n (%)310 (11)60 (12)250 (10)0.65Ostepenizing drug, n (%):1.750289 (57)1.461 (60)0.34 Omeprazole967 (33)178 (35)789 (33)0.60 Thyroxine354 (12)53 (10)301 (12)0.67 Corticosteroids261 (9)42 (8)219 (9)0.83 Aromatasa Inhibitor168 (6)16 (3)152 (6)0.62Treatment, n (%):808 (34)226 (48)582 (24)0.0001 Oral bisphosphonate518 (18)127 (25)391 (16) SERM136 (5)24 (5)112 (5)0.02 Strontium ranelate75 (3)20 (4)55 (2)1 Denosumab51 (2)31 (6)20 (0.8)0.35 Zoledronate12 (0.5)10 (2)2 (<0.1)0.84 Teriparatide16 (0.7)14 (3)2 (<0.1)0.84BMD, mean Tscore (SD): Lumbar spine0.890.04 (1.49)0.05 (1.49)0.89 Femoral neck0.70-1.3 (1.06)-0.54 (1.06)0.0001 Osteoporosis, n (%)108 (4)51 (10)57 (2)0.07 Osteopenia, n (%)981 (33)247 (49)734 (30)0.0001 Total hip-0.31-0.8 (1.12)-0.17 (1.12)0,0001FRAX with BMD, mean (SD): Mean fracture5.2310.6 (5.79)3.99 (5.78)0.0001 Hip fracture1.543.7 (3.58)1.09 (3.58)0.0001The group with OP fractures, are significantly (Table 1): older (p<0.0001), with lower mean age of menopause (p<0.0001), receive more treatment (p<0.0001), especially oral bisphosphonates (p=0.02), have worse results in hip BMD (p<0.0001), with a higher percentage of osteopenia (50% vs 30%, p<0.0001) and worse result in FRAX of major fracture (p<0.0001) and of hip (p<0.001).ConclusionAmong the patients referred to BMD, although the result of lumbar spine is normal, 17% have suffered an OP fracture, presenting this group: 1) Older age, 2) Osteopenia in hip BMD 50%, with high risk of fracture due to FRAX and they followed treatment for OP, especially oral bisphosphonates. 3) It is advisable to simultaneously perform BMD at the lumbar and hip levels, especially in older subjectsAcknowledgementsThe study was supported by a research grant from the Marina Baixa Association for Research in Rheumatology (AIRE-MB).Disclosure of InterestsNone declared