Pos0395 difference in Predictors of Fractures in Patients With Severe Versus Established Osteoporosis

Abstract

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.