AB0701 Frequency and risk factors of osteoporosis in men with systemic scleroderma

Objectives

To identify the frequency and risk factors of osteoporosis (OP) in men with systemic scleroderma (SSc).

Methods

37 men with SSс were enrolled in the study: 19 (51,4%) with limited and 18 (48,6%) with diffuse cutaneous subtype. Patients with overlap rheumatic syndromes were not included. The median age was 56,0 [46,0; 61,0] years, the median duration of the disease was 6,0 [3,0; 9,0] years. 31 (83,8%) patients were treated with glucocorticoids (GC) > 3 months, the median duration of GC use was 3,7 [2,0; 7,0] years. Dual energy X–ray absorptiometry (DXA) of the lumbar spine (LS), the femoral neck (FN) and the total hip (TH) was performed. Osteoporosis (OP) was diagnosed with a T-score < -2.5 SD and osteopenia – with a T-score from -1SD to -2.5 SD at any region of interest. Z-score < -2 SD was used for diagnosis of OP in men < 50 years old. Spearman correlation between BMD and different factors was performed. Traditional and specific risk factors for OP were analyzed using univariate logistic regression analysis.

Results

The median LS BMD was 1,13 [1,03; 1,26] g/cm2, the FN BMD 0,95 [0,84; 0,99] г g/cm2 and the TH BMD - 0,99 [0,93; 1,06] g/cm2. Low BMD at least in one region of interest was detected in 19 (51,4%) patients: OP – in 8 (21,6%) (6 persons 50 years and older and 2 men < 50 years); osteopenia – in 11 (29,7%) men, without significant difference between the subtypes of the disease (p>0,05). 9 (24,3%) men had a history of low-trauma fracture, among them 2 (22,2%) patients had OP, 3 (33,3%) - osteopenia and 4 (44,4%) persons - normal BMD. 5 (27,8%) men with diffuse form and 3 (15,8%) - with limited cutaneous subtype had OP (p>0,05).

BMD in the LS correlated with uric acid (UA) (Rs = 0,59, p<0.05), BMD in the FN and BMD in the TH - with duration of the disease (Rs = -0,39, p<0.05 and Rs = -0,42, p<0.05, respectively), with duration of GC intake (Rs = -0,46, p<0.05 and Rs = -0,51, p<0.05, respectively), with the level of alkaline phosphatase (AP) (Rs = -0,54, p<0.05 and Rs = -0,46, p<0.05). In univariate logistic regression analysis, we found out that only the force vital capacity (FVC) was associated with OP (OR 15,19 [1.15; 199.79], p=0,04). There was no association between OP and other factors such as the duration of the disease or GC intake, the level of UC and AP.

Conclusion

OP was found in 21.6% of men with SSc. There was no statistically significant difference in the frequency of OP depending on the subtype of the disease. Among analyzed factors, only the FVC was positive associated with OP. Further research is needed.

Disclosure of Interests

None declared

AB0703 The need for anti-osteoporotic therapy in patients with systemic sclerosis

Objectives

To determine the need for anti-osteoporotic therapy in postmenopausal women and men over 50 years of age with systemic sclerosis (SSc).

Methods

The study included 150 patients with SSc who met the ACR/EULAR 2013 criteria: 124 (82,7%) postmenopausal women and 26 (17.3%) men over 50 years of age. Median age was 59,0 [54,0; 64,0] years. The duration of the disease was 8,0 [5,0; 14,5] years. A history of fragility fractures was collected. FRAX was calculated in patients without prior fractures to identify patients at high risk of low-energy fractures. Dual-energy X-ray densitometry (DXA) was performed in persons at moderate risk of fractures, and 10-year probability of major osteoporotic fractures was recalculated with the inclusion of a hip neck T-score. DXA was also performed on all patients from the low-risk group who had 2 or more risk factors of OP.

Results

36 (24%) patients had a history of fragility fractures: 21 (16.9%) women and 6 (4.3%) men - vertebrae fracture, 8 (6.5%) women - peripheral fractures, 1 (3.8%) man – hip fracture.

The calculation of the 10-year probability of fractures by FRAX showed that 21 (16,9%) women had a high risk, and another 60 women and 3 men had moderate risk of fractures. After the FRAX recalculation with the inclusion of the femoral neck T-score, only 26 (21,0%) women moved from the moderate-risk group to the high-risk group. All men and 48 women had a low risk of osteoporotic fractures according to FRAX, among them 12 (8,0%) people (4 men and 8 women) had osteoporosis by DXA.

Thus, among SSc patients 84 (67.7%) women and 11 (42,3%) men needed anti-osteoporotic treatment.

Conclusion

As a result of a comprehensive assessment of the risk of fractures and OP, it was found that 63.3% of patients with SSc needed anti-osteoporotic treatment.

Disclosure of Interests

None declared

AB0317 QUALITY OF LIFE AND LOCOMOTIVE FUNCTIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Objectives

To evaluate quality of life and its relationship with muscle strength and physical performance in patients with rheumatoid arthritis (RA).

Methods

157 women with RA (median age was 58.6±8.8 years, median duration of RA was 8.0 [4,0; 14] years) were included in the study. Assessment of functional disability and quality of life was carried out using Health Assessment Questionnaire Disability Index (HAQ), EQ-5D (index and visual analog scale, VAS), Hospital Anxiety and Depression Scale (HADS, with two subscales for anxiety and depression, HADS-A and HADS-D), Rheumatoid Arthritis Impact of Disease (RAID). Also, all patients underwent tests to determine muscle strength by hand dynamometry and test “Chair stand” and physical performance by the Short Physical Performance Battery (SPPB). Dual-energy X-ray absorptiometry of the whole body, lumbar spine and proximal hip was done. Spearman’s correlation test was performed.

Results

88.5% of RA patients had low muscle strength, 61.1% of people had low physical performance. No correlation was found between physical performance and age, RA activity, body composition and BMD. In persons with reduced physical performance, HAQ, EQ-5D index, VAS and RAID were worse than in women with normal physical function (p<0.0001; p<0.0001; p=0.004; p=0.010, respectively). Also, these patients had more pronounced signs of anxiety and depression, assessed using HADS-A (p=0.004) and HADS-D (p=0.001). HAQ positively correlated with the number of comorbidities (r=0.35, p<0.001) and negatively correlated with the SPPB and gait speed (r=0.35, r=-0.39 and r=-0.37, respectively, p<0.001). EQ-5D index positively correlated with SPPB and gate speed (r=0.44 and r=0.39, respectively, p<0.001). HADS-A and HADS-D positively correlated with the number of comorbidities (r=0.35 and r=0.34, respectively, p<0.001). HADS-A negatively correlated with the biological therapy duration (r=-0.36, p=0.032) and with BMI (r=-0.34, p<0.001). HADS-D negatively correlated with the SPPB (r=-0.36, p<0.001). RAID negatively correlated with the biological therapy duration (r=-0.35, p=0.032) and with SPPB (r=-0.35, p<0.001).

Conclusion

88.5% of RA patients had low muscle strength and 61.1% - low physical performance. Quality of life negatively correlated with physical performance.

Disclosure of Interests

None declared

AB0378 EFFECT OF RITUXIMAB ON BONE MINERAL DENSITY IN WOMEN WITH RHEUMATOID ARTHRITIS

Objectives

To compare the effect of rituximab (RIT) treatment on bone mineral density (BMD) in women with rheumatoid arthritis (RA) and those with RA without biological therapy.

Methods

78 women over 40 years with confirmed RA according to ACR/EULAR criteria (2010) were enrolled in the study: 48 patients treated with RIT and methotrexate (RIT+) and 30 women received only methotrexate (RIT-). The patients did not differ in the glucocorticoid therapy duration and cumulative dose. BMD was determined in the lumbar spine, femur neck and total hip using dual energy x-ray absorptiometry (DXA, Hologic 4500A) at baseline and after 1 year. RA activity was evaluated by disease activity score using 28 joint counts and erythrocyte sedimentation rate (DAS28 ESR). Nonparametric statistic tests were performed.

Results

There were no differences between patients RIT+ and RIT- in age (median - 58 [53; 63] years and 52 [50; 69] years, p>0.05), RA duration (median – 15 [4; 21] year and 9 [3; 11] year, p>0.05) and DAS28 ESR (median – 5.18 [4.35; 6.25] and 5.71 [4.66; 5.94]). The percentage BMD changes from baseline in lumbar spine, femoral neck and total hip were 0.2% [-3.9%; 4.0%], -1.8% [-6.2%; 2.4%] and -0.3% [-3.5%; 4.5%], respectively, in patients RIT+ and -1.0% [-4.9%; 3.3%], -2.5% [-5.8%; -0.4%], -1.7% [-4.3%; 4.2%], respectively, in persons RIT-. There were no differences in BMD changes in the pair matching test both patients RIT+ and RIT-. No correlations between BMD changes with age, RA duration and DAS28 ESR were found.

Conclusion

RIT had no effect on BMD in women with RA after 1 year therapy. BMD changes were not associated with age, RA duration and disease activity.

Disclosure of Interests

None declared

AB0316 SARCOPENIA IN PATIENTS WITH RHEUMATOID ARTHRITIS: PREVALENCE AND ASSOCIATED FACTORS

Objectives

To evaluate the prevalence of sarcopenia (SP) and associated factors in patients with rheumatoid arthritis (RA).

Methods

159 women (mean age 58.7±8.8) with confirmed RA according to ACR/EULAR criteria (2010) were enrolled. Hand grip strength was measured using mechanical dynamometry. Dual-energy X-ray absorptiometry (DXA) was performed to assess the body composition and bone mineral density (BMD) of the lumbar spine, femoral neck and total hip. SP was defined as muscle strength < 16 kg and appendicular lean mass index (ALMI) <5.5 kg/m2 or appendicular lean mass (ALM) <15 kg. RA activity was assessed by C-reactive protein (CRP) and disease activity score using 28 joint counts and erythrocyte sedimentation rate (DAS28-ESR). The relation between low ALM with disease parameters was analyzed using Spearman’s r. Factors associated with SP were evaluated using regression analysis.

Results

SP was diagnosed in 33 (20.8%) women with RA. Patients with SP did not differ in age from those without it (59,0±8,9 and 58,7±8,8 years, respectively, p>0,05). 75.8% patients with SP and only 27.8% women without SP had normal BMI (p<0.001). Osteoporosis was diagnosed significantly more often in patients with SP than in women without SP (54.5% and 23.0%, respectively, p<0.001). In women with RA, ALM and ALMI correlated with body mass index (BMI), bone mineral component, BMD and total fat mass. ALM and ALMI did not correlate with age, disease duration, the use of glucocorticoids, DAS28, CRP, total protein, and creatinine levels. In univariate regression analysis, SP was associated with BMI, bone mineral component, BMD of lumbar spine and proximal femur, total fat mass. In multivariate regression analysis, SP was positively associated with the presence of osteoporosis [OR 2.98, 95%CI (1.22-7.30), p = 0.017] and BMI < 25 kg/m2[OR 6.75, 95%CI (2.45-18.56), p <0.001]. No other significant associations were found.

Conclusion

Among patients with RA, 1/5 of them had SP, which was positively associated with BMI and the presence of osteoporosis, but not with the age, activity and duration of the disease.

Disclosure of Interests

None declared

AB0312 BODY COMPOSITION AND BONE MINERAL DENSITY IN PATIENTS WITH RHEUMATOID ARTHRITIS AND OSTEOARTHRITIS

Objectives

To assess body composition and bone mineral density (BMD) in rheumatoid arthritis (RA) women compared to patients with osteoarthritis (OA).

Methods

133 women with RA and 45 women with OA aged 50 and over were enrolled in the study. Body composition (fat mass (FM), lean mass and bone mineral component (BMC)) and BMD of the lumbar spine, femoral neck and total hip were measured using dual-energy X-ray absorptiometry (DXA). Appendicular muscle mass (AMM) and appendicular mass index (AMI) were calculated. Muscle strength was assessed in all patients. The criteria of the European Working group on Sarcopenia in Older people 2 (EWGSOP2) were used for low muscle mass and sarcopenia. Osteoporosis was determined in accordance with WHO criteria.

Results

Mean age of RA patients and women with OA was 61.3±7.1 and 61.9±6.2 years, respectively (p>0.05). BMC and AMM were lower in RA patients than in women with OA: BMC - 1948.6±425.7g and 2167.1±398.1g, respectively (p=0.004); AMM - 17.5±2.9 kg and 20.1±2.7 kg, respectively (p<0.001). 27 (20.3%) RA women and only 1 (2.2%) person with OA had low AMM (p=0.004). The mean value of AMI was 6.8±1.0 kg/m2 and 7.5±0.9 kg/m2 in RA and OA patients, respectively (p<0.001). Total FM was 28.3±8.5 kg and 33.2±9.8 kg in RA and OA women, respectively (p=0.003). At the same time, we found no differences in the percentage of fat mass: 39.2±5.7% in RA patients and 39.9±5.8% in persons with OA (p>0.05). Overfat was discovered in 99 (77.4%) and 38 (84.4%) in women with RA and OA, respectively (p>0.05). All women with low AMM/AMI had low muscle strength and were diagnosed with confirmed sarcopenia.

In RA patients BMD at any region was less than in women with OA: in the lumbar spine – 1.026±0.174 g/сm2 and 1.114±0.177 g/сm2, respectively (p=0.009); in the femoral neck – 0.844±0.151 g/сm2 and 0.914±0.137 g/сm2, respectively (p=0.005) and in the total hip 0.878±0.148 g/сm2 and 0.986±0.117 g/сm2, respectively (p<0.001). Normal BMD was found in 33 (24.8%) and 24 (53.3%) women with RA and OA, respectively (p=0.0004). 42 (31.6%) patients with RA and 6 (15.4%) women with OA had osteoporosis (p=0.017).

Conclusion

RA patients had lower BMC, AMM/AMI, total FM and BMD compared to women with OA, and they were significantly more likely to have sarcopenia and osteoporosis.

Disclosure of Interests

None declared

AB0677 Frequency and risk factors of osteoporosis in fertile women with systemic scleroderma

Objectives

To determine the frequency and risk factors of osteoporosis (OP) in fertile women with systemic scleroderma (SSс)

Methods

64 women (36,0 [31,5; 43,5] years old) with SSс were enrolled in the study: 35 (54,7%) with limited and 29 (45,3%) with diffuse cutaneous subtype without overlap rheumatic syndromes. The median disease duration was 5,0 [2,0; 9,0] years. Glucocorticoids (GC) were taken by 49 (76,6%) patients with the median duration of treatment 5,0 [2,0; 10,0] years. Dual energy X–ray absorptiometry (DXA) of the lumbar spine, the femoral neck and the total hip was performed. To estimate the value of the BMD the Z-score was used. Low BMD was considered at a Z-score < -2.0 SD. A univariate logistic regression analysis was performed to analyze the factors associated with OP.

Results

Low BMD was detected in 8 (12.5%) patients. 5 (7,8%) women had a history of low-trauma fracture, among them only 1 (1,6%) patient had low BMD and 4 (6,2%) persons - normal BMD.

A univariate logistic regression was performed to identify OP risk factors. Among traditional risk factors, low body mass index (BMI) associated with OP (OR 1,39 [1.04; 1.88], p=0,03) and falls during the past year (OR 5,25 [1.04; 26.36], p=0,04). Among specific ones – duration of SSc (OR 1,19 [1.02; 1.39], p=0,02), duration of GC using (OR 1,11 [1.00; 1.23], p=0,04), hand joint contractures (OR 8,54 [1.41; 51.63], p=0,02). There was no effect of smoking, treatment with proton pump inhibitors, family history of osteoporosis, age, subtype SSc, modified Rodnan score, digital ulcer, cutaneous calcification, esophageal hypotension, interstitial lung disease, diffusing capacity of the lung for carbon monoxide, force vital capacity, CRP, erythrocyte sedimentation rate, creatinine, presence of antinuclear antibody, anticentromere antibody or antitopoisomerase I antibody on the development of OP in fertile women with SSс.

Conclusion

Low BMD was detected in 12.5% of fertile women with SSс. Low BMI, falls during the past year, duration of SSs and GC taking, hand joint contractures associated with OP.

Disclosure of Interests

None declared

AB0294 VITAMIN D LEVEL AND LOCOMOTIVE FUNCTIONS IN WOMEN WITH RHEUMATOID ARTHRITIS

Background

Muscle health is an important aspect of rheumatoid arthritis (RA). A decrease in muscle mass and physical performance is a frequent complication of RA that contributes to inability to work and reduced quality of life. Vitamin D deficiency is also common in these patients.

Objectives

To assess the relationship between vitamin D level, muscle strength and physical performance in RA patients.

Methods

135 women (mean age 58.5±8.9) with confirmed RA according to ACR/EULAR criteria (2010) were enrolled in the study. Muscle strength of upper extremities was measured using a mechanical dynamometer, of lower extremities – using “Chair stand test” (CST) – assessment of the ability to rise from a chair and sit back down 5 times. Handgrip strength 16 kg and less or CST for more than 15 seconds were the criteria for low muscle strength. All patients underwent “Gate speed test” (GST) and “Timed Up and Go test” (TUG) to assess the physical performance. Serum level 25 (OH)D was performed using the Cobas E411 immunochemiluminescence analyzer and Elecsys Vitamin D total kit, Roche.

Results

Median 25(OH)D level was 23.7 [18.2; 30.7] ng/ml in RA women with minimum 7.9 ng/ml and maximum 70.0 ng/ml.

Insufficiency and deficiency of vitamin D were detected in 56 (41,5%) and 42 (31,1%) women, respectively, with median level 24.1 [21.8; 26.6] ng/ml in the patients with insufficiency and 15.6 [13.6; 17.9] ng/ml – in deficiency group.

Vitamin D level was compared between patients with low muscle strength and/or physical performance and women with normal locomotive functions (Table 1). 25(OH)D level was significantly higher in RA women with normal CST and GST >0,8 m/s than in patients with the worst results of these tests. At the same time, we didn’t find differences in handgrip strength and TUG depending on vitamin D level.

Table 1.

25(ОН)D in women with RA according to locomotive functions

Test25(ОН)DрCST≤15 seconds26,7 [20,4; 32,2]0,036>15 seconds21,0 [17,9; 25,1]GST>0,8 m/s26,1 [19,6; 32,0]0,043≤0,8 m/s21,1 [17,0; 26,8]Handgrip strength≥16 kg23,8 [17,8; 30,2]>0,05<16 kg27,7 [19,5; 32,2]TUG<20 seconds23,7 [17,9; 30,1]>0,05≥20 seconds18,8 [18,1; 21,0]

Conclusion

The frequency of low vitamin D level was 72,6% in women with RA including deficiency in 31,1% patients. Patients with reduced lower limb strength and low walking speed had significantly lower vitamin D levels, but there were no differences in 25(OH)D and other tests (handgrip strength and TUG).

Disclosure of Interests

None declared

POS0164 THE NEED FOR ANTI-OSTEOPOROTIC INTERVENTION IN POSTMENOPAUSAL WOMEN WITH RHEUMATOID ARTHRITIS BASED ON THE FRACTURE RISK ASSESSMENT

Background:

Rheumatoid arthritis (RA) is a chronic disabling disease that is associated with bone loss. Previous studies estimated that approximately one-third of the RA patients had osteoporosis (OP). However, most fragility fractures occur in patients not suffering from OP, that can be partly explained by impaired quality of bone, which is not measured with DXA. Therefore, only the measurement of bone mineral density is not sufficient to determine the indication for OP treatment. Another tool for assessing the need for anti-osteoporotic therapy is to calculate the 10-year probability of a major fracture using the fracture risk assessment tool (FRAX).

Objectives:

To assess the need for anti-osteoporotic therapy in women with rheumatoid arthritis (RA) based on the identification of individuals with fragility fractures and high risk of fracture according to FRAX.

Methods:

295 postmenopausal women with RA were included in the study. The average age was 63±7 years, the duration of RA was 11 [4;16] years, the duration of postmenopausal period was 13 [6; 20] years. 121 (41%) patients took glucocorticoids (cumulative dose 9025 [3650; 20720] mg in prednisolone equivalent). A survey was conducted to identify patients with risk factors and a history of fragility fractures. The 10-year probability of a major osteoporotic fracture was assessed using the FRAX tool. In patients treated with glucocorticoids at a dose >7.5 mg in prednisolone equivalent the estimates of probabilities of a major osteoporotic fracture were adjusted in accordance with the recommendations [1]. Dual-energy X-ray absorptiometry (DXA) of the proximal femur was performed in patients with a moderate risk (probabilities between the upper and lower assessment age-dependent intervention threshold) and the risk of fracture was recalculated with including femoral neck BMD.

Results:

83 (28.1%) patients had a prior fragility fracture: 44 (14,9%) – 1, 20 (6,8%) – 2 and 19 (6.4%) – 3 or more. Vertebral fractures were the most common, they accounted for 62,1% of all fractures, distal forearm was the second frequent fractures localization (18.2%). Only 2 (0.7%) women had hip fracture. The average 10-year probability of a major osteoporotic fracture was 17 % [11; 28] in RA women. 92 (31.2%) persons were at high risk, 28 (9.5%) patients - at low risk, and 175 (59.3%) - at moderate risk. After recalculation of fracture risk with including femoral neck BMD in people at moderate risk 48 (16.3 %) patients became at high risk, 9 (3.1%) – at very high risk, and 118 (40.0%) - at low risk.

Thus, 149 (50.5%) RA patients were at very high or high risk and 146 (49,5%) – at low risk of major osteoporotic fracture according to FRAX, among the last – only 3 persons had a history of fragility fracture after age of 40 years.

Conclusion:

Our study demonstrated that a half of postmenopausal women with RA had indications for anti-osteoporotic treatment based on the results of a 10-year probability of major fragility fractures using FRAX tool.

References:

[1]Kanis JA, Johansson H, Oden A, McCloskey EV. Guidance for the adjustment of FRAX according to the dose of glucocorticoids. Osteoporos Int. 2011;22(3):809-816. doi:10.1007/s00198-010-1524-7.

Disclosure of Interests:

None declared

POS0841 RISK FACTORS OF LOW BONE MINERAL DENSITY IN WOMEN WITH SYSTEMIC SCLEROSIS

Background:

Chronic inflammatory rheumatic diseases are risk factors of bone loss and fractures. Systemic sclerosis (SSc) has been recognized to be another potential inflammatory joint disease that may affect bone tissue.

Objectives:

to evaluate bone mineral density (BMD) and risk factors of low BMD in women with SSc.

Methods:

173 women, among them 110 postmenopausal (median age 60[55,63] years) and 63 premenopausal (median age 35[31,44] years). BMD was measured at lumbar spine (LS), femoral neck (FN) and total hip (TH) by dual energy X-ray absorptiometry (DXA, Hologic 4500A). Low BMD was diagnosed if the T-score was < -1.0 standard deviation (SD) in postmenopausal women and if the Z-score was < -2.0 SD in premenopausal women. The relationship between BMD and SSc patients’ characteristics was evaluated using univariate linear regression analysis.

Results:

Low BMD was found in 66% patients: 79% - in postmenopausal and 18% - in premenopausal women. Among postmenopausal persons osteoporosis was discovered in 47% and osteopenia – in 32% cases. In postmenopausal woman BMD of LS, FN and TH were associated with body mass index (BMI) (β=0.27, p=0.010; β=0.47, p<0,001 and β=0.45, p<0,001, respectively), duration of glucocorticoids (GCs) using (β=-0.31, p=0.008; β=-0.34, p=0.003 and β=-0.27, p=0.022, respectively); BMD of FN and TH with C-reactive protein (β= -0.32, p=0.016 and β= -0.29, p=0.029, respectively) and LS BMD with current and cumulative GCs dose (β= -0.24, p=0.039 and β= -0.29, p=0.014, respectively). In premenopausal women BMD of LS, FN and TH were associated with BMI (β=0.51, p<0,001; β=0.45, p=0.003 and β=0.47, p=0.002, respectively), duration of GCs using (β= -0.45, p=0.004; β= -0.47, p=0.003 and β= -0.48, p=0.002, respectively) and GCs cumulative dose (β= -0.48, p=0.002; β= -0.51, p=0.001 and β= -0.46, p=0.004, respectively); BMD of FN and TH with 25(ОН)D level (β=0.52, p=0.008 and β=0.54, p=0.005, respectively), and LS BMD with SSc duration (β= -0.44, p=0.004).

Conclusion:

Low BMD was diagnosed in 66% of women with SSc. Low BMI, GCs cumulative dose and duration of GCs using were independent risk factors for low BMD in both premenopausal and postmenopausal persons. Additional factors as SSc duration and low vitamin D level were found out for premenopausal and current GCs dose and C-reactive protein level for postmenopausal women.

Disclosure of Interests:

None declared

AB0176 PATHOLOGICAL PHENOTYPES OF BODY COMPOSITION IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Inflammation, decreased physical activity, hormonal disorders, and the use of glucocorticoids lead to changes in the composition of the body in rheumatoid arthritis (RA). Various combinations of decreased muscle and bone mass and increased adipose tissue have led to the release of various pathological phenotypes of the composition of the body.

Objectives:

To determine the frequency of pathological phenotypes of body composition in patients with RA.

Methods:

The study included 79 women with RA, with a median age of 60 y.o. [55; 65]. 92% of the women were postmenopausal. The median duration of the disease was 9 years [3; 11]. Basic anti-inflammatory therapy was received by 81% of patients. Methotrexate was used most often as the basic therapy – in 52% of cases. 49% of patients were treated with glucocorticoid drugs. All patients underwent dual-energy X-ray absorptiometry. The mineral density of the tissues was determined in the standard measurement areas - the spine and the proximal thigh, and the content of muscle and adipose tissue was analyzed. We calculated appendicular muscle mass (AMM), which is the sum of upper and lower limb muscle mass and appendicular muscle index (AMI), the ratio of appendicular muscle mass to the square of height. AMM< 15 kg, AMI < 6 kg / m2 corresponds to sarcopenia.

Results:

The average AMM was 17.8±3.0 kg. 18% patients had AMM <15 kg / m2. The average AMI was 6.8±1.0 kg / m2. 25% patients had AMI < 6 kg/m2. The average body mass index (BMI) was 27.6±4.8 kg/m2. 37% patients were overweight (25≤ BMI <29.9 kg/m2), 28% of women had a BMI corresponding to obesity. The average fat content was 28.2 kg. 71% of women had an obesity, according to X-ray absorptiometry, which is 2.5 times higher than the number of cases of obesity detected by BMI. A decrease a bone mineral density (BMD) was found in 73% of women, including osteoporosis in 25%. The most frequent phenotype was osteopenic obesity (Table 1), which was detected in almost 40% of patients. Isolated osteoporosis (16.5%) and obesity (17.7%) and osteosarcopenic obesity (16.5%) were found with approximately the same frequency. Osteosarcopenia was found in 9% of patients. In 4%, no changes in the compositional composition of the human body were detected.

Table 1.

Pathological phenotypes of body composition

Pathological phenotypes of body compositionn=79Osteoporosis, n (%)13 (16,5)Obesity, n (%)14 (17,7)Osteosarcopenia, n (%)7 (8,9)Osteopenic obesity, n (%)29 (36,7)Osteosarcopenic obesity, n (%)13 (16,5)

Conclusion:

The overall frequency of pathological phenotypes of body composition was high and amounted to 96.2% in women with RA. The most common pathological phenotype was an osteopenic obesity characterized by a decrease in BMD and an increase in fat mass.

Disclosure of Interests:

None declared

AB0154 USAGE OF THE SARC-F QUESTIONNAIRE FOR SARCOPENIA SCREENING IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Sarcopenia, characterized by low muscle strength and low muscle quantity or quality and associated with increased risks of falling and mortality. The prevalence of sarcopenia is 37% among patients with RA [1]. However, in clinical practice settings, sarcopenia among RA patients remains underdiagnosed. The SARC-F questionnaire [2] was recommended by the European Working Group on Sarcopenia in Older People (EWGSOP) before performing muscle strength tests and assessment muscle mass.

Objectives:

To evaluate the diagnostic value of the SARC-F questionnaire for the screening of sarcopenia (SP) in women with rheumatoid arthritis (RA).

Methods:

83 women (average age 59±8 years) with RA without aseptic bone necrosis, joint replacement and severe comorbidities were recruited. All patients were interviewed with the SARC-F questionnaire. The summation score ≥ 4 corresponded to cut-off for suspected sarcopenia. Sarcopenia was evaluated using the European Working Group on Sarcopenia in Older People (EWGSOP2), which included dual-energy X-ray absorptiometry (DXA), handgrip strength or chair stand test, and gait speed. The sensitivity, specificity, positive and negative prognostic values of the SARC-F questionnaire were estimated.

Results:

Confirmed SP was diagnosed in 20 (24%) RA patients, who had low muscle strength and mass. When conventional cut-off point (≥4) for SARC-F questionnaire was applied, only 30% of the patients with SP met this condition (sensitivity 30%, 95% confidence interval [95% CI] 13% to 54%), and 41% of the patients without SP did not meet this condition (specificity 41%, 95% CI 29% to 54%). Positive and negative prognostic values were 14% (95% CI 6% to 29%) and 65% (95% CI 48% to 79%), respectively.

Conclusion:

The SARC-F questionnaire alone is not adequate for screening of SP in RA patient. It is necessary to develop other simple screening methods that can easily be carried out in real clinical practice to identify individuals with possible SP for further diagnostic tests.

References:

[1]Torii M, Hashimoto M, Hanai A, et al. Prevalence and factors associated with sarcopenia in patients with rheumatoid arthritis. Modern Rheumatology, 2018;29(4):589-595. doi:10.1080/14397595.2018.1510565.

[2]Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31. doi:10.1093/ageing/afy169.

Disclosure of Interests:

None declared

POS0518 DIAGNOSTIC VALUE OF MUSCLE STRENGTH TESTS FOR THE DIAGNOSIS OF SARCOPENIA IN RHEUMATOID ARTHRITIS PATIENTS

Background:

Motor disorders in patients with rheumatoid arthritis (RA) may be associated with sarcopenia (SP). The frequency of secondary SP in RA patients reaches 17 - 37% [1, 2]. Currently, in patients with RA muscle strength is evaluated by methods proposed in geriatric practice [3].

Objectives:

To determine the sensitivity, specificity, diagnostic accuracy, positive and negative predictive value of handgrip strength (HS) and chair stand test (5-times sit-to-stand, CST) for the diagnosis of sarcopenia (SP) in women with rheumatoid arthritis (RA).

Methods:

87 women (aged 40-75 years) with RA were enrolled in the study. We did not include patients with aseptic bone necrosis, femoral and knee endoprostheses and comorbidity that negatively affected on the bone tissue. All patients underwent handgrip strength by mechanical dynamometer and CST. Handgrip strength less than 16 kg and CST more than 15 seconds were the criteria for probable SP. Assessment of muscle mass was carried out by dual-energy x-ray absorptiometry («Discovery A» Hologic, USA). Reduced muscle mass was determined as a decrease in appendicular muscle mass (AMM) < 15 kg or appendicular mass index (AMI) < 5.5 kg/m2. Confirmed SP was diagnosed when there was a combination of low muscle strength and reduced muscle mass. For both tests of muscle strength assessment, the sensitivity, specificity, diagnostic accuracy of the method, as well as their positive and negative predictor value for the diagnosis of SP were calculated.

Results:

Low handgrip strength and 5-times CST more than 15 seconds were found in 63 (72%) and 54 (62%) women, respectively. Among them only 20 (23%) patients had low AMM or AMI, so in these women SP was confirmed. For the handgrip strength the sensitivity of the method was 95%, and the specificity - only 34%, the diagnostic accuracy was 48%. The positive prognostic value of this test was 30%, and the negative value - 96%. The sensitivity, specificity and diagnostic accuracy of the CST were significantly lower than the handgrip strength and amounted to 50%, 21% and 28%, respectively. The prognostic value of this test, both positive (16%) and negative (58%), was also significantly lower than the assessment of handgrip strength in RA patients.

We evaluated the diagnostic value of combination of two tests to identify individuals with probable SP: the sensitivity, specificity and diagnostic accuracy were 65%, 30% and 39%, respectively. Negative and positive predictive values were 71% and 24%, respectively, for combination of 2 tests, which was better than using only CST, but worse than using only hand dynamometry.

Conclusion:

Muscle strength tests proposed by the European Working Group on Sarcopenia in Older People have a low specificity, diagnostic accuracy and positive predictive values for detecting SP in RA patients, which requires the development of other methods of the first step of diagnosis of SP in RA patients.

References:

[1]Torii M, Hashimoto M, Hanai A, et al. Prevalence and factors associated with sarcopenia in patients with rheumatoid arthritis. Modern Rheumatology, 2018;29(4):589-595. doi:10.1080/14397595.2018.1510565

[2]Vlietstra L, Stebbings S, Meredith-Jones K et al. Sarcopenia in osteoarthritis and rheumatoid arthritis: The association with self-reported fatigue, physical function and obesity. PLoS ONE, 2019;14(6):e0217462. doi:10.1371/journal.pone.0217462

[3]Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31. doi:10.1093/ageing/afy169

Disclosure of Interests:

None declared

AB0613 FREQUENCY AND RISK OF FRAGILITY FRACTURES IN PATIENTS WITH SYSTEMIC SCLEROSIS

Background:

Objectives:

To assess the frequency of fragility fractures and the 10-year risk of major osteoporotic fractures using the fracture risk assessment tool (FRAX) tool in patients with systemic sclerosis (SSc).

Methods:

The study included 136 patients with SSc who met the ACR/EULAR 2013 criteria: 110 (80.9%) postmenopausal women and 26 (19.1%) men over 50 years of age, mean age 59,3 + 7.5 years. The duration of the disease was 10,0 [6.0; 15.0] years in women and 6,0 [3.5; 9.0] years in men. A questionnaire was conducted and the risk of major osteoporotic fractures was calculated according to FRAX tool, as a result of which patients were divided into groups of low, moderate or high risk. Individuals at moderate risk underwent dual-energy X-ray absorptiometry (DXA) of the proximal femur, followed by a 10-year probability of major osteoporotic fractures recalculation with the inclusion of the femoral neck T-score. According to the obtained fracture risk assessment tool value, patients were assigned as having a low, high or very high risk.

Results:

Fragility fractures of various localization were found in 50 (36,7%) people: 41 (37,3%) women and 9 (34.6%) men. Vertebral and peripheral bone fractures occurred with the same frequency (19,8%) without significant differences depending on the patient’s gender. Only 1 (3,8%) male had a history of proximal femoral fracture. Fractures of both the vertebra and the peripheral bone occurred in 4 (2,9%) people: 3 (2,7%) women and 1 (3,8%) man.

9 (8,2%) women and 16 (61,5%) men had a low risk of major osteoporotic fractures according to FRAX, 60 (54,5%) and 10 (38,5%) - a moderate risk, respectively, while 41 (37,3%) women were at high risk. Among 86 patients without a history of low-energy fractures (69 women and 17 men), 8 (11,6%) women and 16 (94,1%) men were at low risk of major osteoporotic fractures, and 57 (82,6%) and 1 (5,9%), respectively, were at moderate risk. Only 4 (5,8%) women were assigned to the high-risk group. After recalculation of the fracture risk assessment tool with inclusion of the femoral neck T-score in persons with moderate risk without a history of fragility fractures, 9 (13,0%) women and 1 (5,9%) man were found to be at high risk, 14 (20,3%) women - at very high risk and 34 (49,3%) women - at low risk.

Among moderate-risk patients with prior fractures after FRAX recalculation 3 (7,3%) women and 7 (77,8%) men became at low risk, 1 (11,1%) male - at high and 1(11,1%) male – at very high risk. Thus, 55 (50,0%) women and 1 (3,8%) man were at very high, 12 (10,9%) and 2 (7,7%), respectively, - at high, and 43 (39,1%) and 23 (88,5%), respectively, - at low risk of major osteoporotic fractures.

Conclusion:

In the examined cohort of patients with SSc, the frequency of fragility fractures was 37,3% in women and 34,6% in men. A high and very high risk of major osteoporotic fractures was found in 60,9% of women and 11,5% of men. 3 (2,7%) women and 6 (23,1%) men with a history of previous fractures were in the low-risk group by FRAX, but they need to consider the appointment of anti-osteoporotic therapy as for patients at high and very high risk.

Disclosure of Interests:

None declared.

POS0839 BODY COMPOSITION AND FREQUENCY OF SARCOPENIA IN PATIENTS WITH SYSTEMIC SCLEROSIS

Background:

Sarcopenia can be age associated (primary form) or secondary to chronic disorders, including rheumatic inflammatory disorders. Systemic sclerosis (SSc) is a chronic autoimmune rheumatic disease characterized by widespread vasculopathy, progressive fibrosis of the skin and other internal organs, such as lung, kidneys, gastrointestinal tract, cardiovascular system. Different from the other chronic rheumatic inflammatory disorders, sarcopenia has not been well evaluated in SSc patients.

Objectives:

To assess the body composition (BC) and to identify the frequency of sarcopenia (SP) in SSc patients.

Methods:

A total of 44 women who met the ACR/EULAR 2013 classification criteria were included. Mean age was 53,2 + 8,8 years. The median disease duration was 7,0 [4,0;12,0] years. 26 (59,1%) patients had limited and 18 (40,9%) - diffuse cutaneous subtype. Body composition was measured using Dual-energy X-ray absorptiometry (DXA) of whole body. The appendicular lean mass index (ALMI) was calculated as the ratio of appendicular lean mass (ALM) to height (kg/m2). Handgrip measurement and chair stand test were performed. Physical function was measured with the Short Physical Performance Battery (SPPB). SP was diagnosed in agreement with the 2019 revised consensus on definition and diagnosis of SP of the European Working Group on Sarcopenia in Older People 2 (EWGSOP2): handgrip <16kg, chair stand test > 15 seconds for 5 rises, ALM <15 kg or ALMI <5.5 kg/m2. Severe SP was detected if the patient additionally had gait speed ≤0.8 m/s or SPPB ≤ 8-point score. Overfat was defined as body fat percentage >35%.

Results:

The median bone mineral content was 2.0 [1.8; 2.2] kg, total lean mass - 39,5 [35,7; 45,5] kg, ALM - 16,3 [14,5;19,4] kg, ALMI – 6,5 [5,7; 7,2] kg/m2, trunk fat mass – 13,5 [9,1; 16,7] kg and total fat mass - 26,6 [20,1; 34,5] kg. Body fat percentage was 38,8% [34,2; 42,7].

9 (20,5%) women had low ALM and low ALMI, 6 (13,6%) – only low ALM. Healthy BC was found in 5 (11,3%), low ALM or low ALMI – in 7 (15,9%), overfat – in 24 (54,5%), low ALM + overfat – in 8 (18,2%) patients. We found no differences in BC between SSc patients with limited and diffuse cutaneous subtype.

Low muscle strength (SP probable) was found in 21 (47,7%) women, meanwhile confirmed SP (low muscle strength and muscle mass) was diagnosed in 10 (22,7%) patients, among them 5 (11,4%) persons had severe SP. No significant difference in SP frequency among patients with limited and diffuse cutaneous SSc 4 (15,4%) and 6 (33,3%), respectively, (p=0,27). Osteoporosis was found in 6 (60%) patients with SP without differences in SSc subtypes.

Conclusion:

Healthy BC was found only in 11,3% cases, while overfat - in 72,7% and low ALM – in 34,1% SSc patients. SP was detected in 22.7% of women, among them in half of cases - severe SP, without any differences between the limited and diffuse subtypes of the disease.

Disclosure of Interests:

None declared

POS0519 BONE MINERAL DENSITY, LEAN AND FAT MASS IN POSTMENOPAUSAL WOMEN WITH RHEUMATOID ARTHRITIS

Background:

The relationship between lean mass (LM), fat mass (FM) and bone mineral density (BMD) remains controversial. Some population studies have emphasized the positive association between them, while others have found an inverse relationship. RA patients are characterized by a decrease in muscle mass and an increase in fat mass. Such changes in body composition may be associated with low BMD.

Objectives:

To study the relationship between BMD, LM and FM in postmenopausal women with RA.

Methods:

68 postmenopausal women with RA (median age 59 [54; 63] years) were included in the study. BMD and body composition were evaluated using two-energy X-ray absorptiometry. Correlation analysis between body composition parameters and BMD was performed with the Spearman method, correlation coefficients R for p<0.05 are presented.

Results:

The average L1-L4 BMD was 0,92±0,16 g/cm2, total hip BMD - 0,84±0,15 g/cm2 and femoral neck - 0,73±0,13 g/cm2. 33 (48.5%) women had osteopenia, and 17 (25.0%) - osteoporosis (OP). Low appendicular LM was found in 5 (7.4%) and low appendicular muscle index (appendicular LM/height2, AMI) – in 10 (14.7%) patients. Overfat was revealed in 47 (69.1%) women, but only 20 (29.4%) women had BMI corresponding to obesity. The positive correlations between BMD in L1-L4, total hip and femoral neck regions and body weight (R=0.46, R=0.56 and R=0.50, respectively), trunk fat (R=0.4, R=0.51 and R=0.37, respectively), total FM (R=0.27, R=0.43 and R=0.34, respectively), trunk LM (R=0.55, R=0.54 and R=0.51, respectively), total LM (R=0.51, R=0.50 and R=0.52, respectively), appendicular LM (R=0.31, R=0.29 and R=0.37, respectively) and AMI (R=0.26, R=0.33 and R=0.51, respectively) were found out. In the multivariate linear regression analysis total LM was associated with BMD of lumbar spine (β=0.638, p=0.001) and total hip (β=0.473, p=0.008), and AMI - with femoral neck BMD (β=0.360; p=0.014). We found that FM hadn’t a significant effect on BMD in any region.

Conclusion:

73.5% of patients with RA had a reduced BMD, and 14.7% women – low AMI. LM was positively associated with BMDs in different regions of interest, but FM had no effect on BMD. Further researches are needed to identify associations between body composition, inflammatory activity and bone health in patients with RA.

Disclosure of Interests:

None declared

AB0267 BODY COMPOSITION IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Rheumatoid arthritis (RA) is a complex inflammatory disease that modifies body composition. Using the dual-energy x-ray absorptiometry (DXA) in RA patients could be a method for body composition changes detection.

Objectives:

To study the body composition using DXA in patients with RA.

Methods:

The study involved 79 women with RA, median age 60 [55; 65] years. The bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry using «Discovery A» (Hologic, USA). Assessment of body composition was carried out, using the program «Whole body». Sarcopenia (SP) was diagnosed as a decrease in appendicular mass index (AMI) <6.0 kg/m2. Osteoporosis (OP) was diagnosed as a decrease in T-score <-2.5 SD. Osteosarcopenia was determined when T-score was <-1.0 SD, AMI was <6.0 kg/m2, osteosarcopenic obesity - T-score was <-1.0 SD, AMI was <6.0 kg/m2and total fat was >35%.

Results:

The mean duration of RA was 9 [3; 11] years. The mean body mass index (BMI) was 27.6±4.8 kg/m2. Disease activity score in 28 joints-erythrocyte sedimentation rate was 4.5±1.3 points for the group. 39 (49.3%) patients used oral glucocorticoids continuously. Appendicular muscle mass and AMI were on average 17.8±3.0 kg and 6.8±1.0 kg/m2, respectively. AMI <6 kg/m2was detected in 20 (25.3%) patients. 56 (70.9%) women with RA had total fat > 35%, while only 22 (27.8%) of women with RA had obesity according to BMI (BMI >30 kg/m2). Isolated OP was found in 13 (16.5%), osteosarcopenia in 7 (8.9%) and osteosarcopenic obesity in 13 (16.5%) patients RA. No cases with isolated sarcopenia or sarcopenic obesity were detected. Only 3 (3.8%) patients did not have appendicular muscle mass, AMI and BMD decrease and overfat or obesity.

Conclusion:

About 97% women with RA had abnormal body composition phenotype: 16,5% - OP, 8.9% -osteosarcopenia, 16,5% - osteosarcopenic obesity and 54,4% - overfat.

Disclosure of Interests:

None declared

SAT0094 ASSESMENT OF BONE MINERAL DENSITY AND FRACTURE RISK IN PATIENTS WITH RHEUMATOID ARTHRITIS AND SARCOPENIA

Background:

The problem of sarcopenia (SP) in rheumatoid arthritis (RA) is particularly significant in terms of assessing the risk of fractures, since SP leads to falls, which are an independent risk factor for fractures along with RA and osteoporosis.

Objectives:

To evaluate the bone mineral density (BMD) and fracture risk in women with RA and SP.

Methods:

79 women with RA based on the 2010 ACR/EULAR classification criteria were included: 20 (25%) women with confirmed SP (age median 59 [53; 64]) according to EWGSOP2 criteria and 59 (75%) women without SP (age median 60 [55; 67]) (p>0.05). We assessed clinical data: age, body mass index (BMI), disease duration, anthropometric measurements, C-reactive protein level, disease activity score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR), previous medication use including glucocorticoids and methotrexate, muscle strength and function. Dual-energy X-ray absorptiometry (DXA) to measure BMD of lumbar spine (LS), femoral neck (FN) and total hip (TH) was performed. The 10-year probability of major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture) and the 10-year probability hip fracture was calculated using the Russian version of the FRAX® tool. Statistical analysis was performed using non-parametric methods. All patients signed an informed consent to participate.

Results:

Median BMD in LS was 0.892 [0.772; 1.024] g/cm2in patients with SP and 0.910 [0.785; 1.028] g/cm2- without SP (p>0.05). There was significant difference between groups in the proximal femur BMD: 0.760 [0.731; 0.826] g/cm2in TH and 0.681 [0.607; 0.703] g/cm2in FN in patients with SP and 0.838 [0.735; 0.921] g/cm2in TH and 0.719 [0.622; 0.804] g/cm2in FN in patients without SP (p=0.009 and p=0.048, respectively). The frequency of osteoporosis was 35% and 22% in patients with and without SP (p>0,05). The 10-year probability of major osteoporotic fracture with / without femoral neck BMD data was 22,0% [17,0; 32,0] / 19,5% [18,5; 22,5 and 13,3% [9,8; 18,5] / 12,8% [9,3; 17,0] in patients with SP and without SP (р<0.05) and the 10-year probability of hip fracture with / without femoral neck BMD data - 3,1% [3,0; 7,5] / 3,1% [2,3; 3,3] and 1,4% [0,9; 2,78] / 0,65 [0,4; 1,7], respectively (р<0.05).

Conclusion:

There were no differences in the frequency of osteoporosis between patients with SP and without SP, however women with SP had proximal femur BMD less than women without SP. The probability of major osteoporotic fracture and hip fracture was significantly higher in patients with RA and SP compared with patients without SP.

Disclosure of Interests:

None declared

AB0915 BONE MINERAL DENSITY AND FRACTURE FREQUENCY IN PREMENOPAUSAL WOMEN WITH RHEUMATIC DISEASES

Background:

The onset of the disease in young and middle age is typical for rheumatic diseases (RDS), but most studies on osteoporosis were conducted in patients (pts) older than 50 years, which included postmenopausal women.

Objectives:

To assess bone mineral density (BMD), fracture frequency and the factors associated with low BMD in premenopausal women with RDs.

Methods:

160 women (median age, 36 [29; 43] years): 120 pts with RDs (43 rheumatoid arthritis (RA), 53 systemic sclerosis (SSc) and 24 psoriatic arthritis (PsA)) and 40 age-matched healthy controls were enrolled in the study. We performed a dual-energy X-ray absorptiometry (DXA, Hologic Discovery A, USA) to measure BMD in lumbar spine, femoral neck and total hip. BMD decreasing grade was evaluated by the Z-score <-2SD. All pts were interviewed using a unified questionnaire including assessment of daily dietary calcium intake. Serum vitamin D, C-reactive protein and erythrocyte sedimentation rate (ESR) measurements were done.

Results:

25% pts with RDs and only 8% healthy controls have low BMD (p=0.02). RA, SSc and PsA pts had low BMD in 37%, 21% and 13%, respectively, that was more often than in healthy women (p=0.004, p=0.046 and p= 0.081, respectively). 9,3% RA pts and 7,5% SSc pts had low energy fractures. BMD of RDs pts in all areas of measurement demonstrated a direct correlation with height, weight, body mass index, and serum vitamin D concentration and an inverse correlation with the cumulative dose of glucocorticoids. Also, proximal femur BMD inversely correlated with RDs duration. BMD of femoral neck and total hip inversely correlated with C-reactive protein level in SSc pts. In RA women we found a direct correlation between lumbar spine and femur neck BMD and ESR.

Conclusion:

25% of premenopausal women with RDs had reduced BMD and needed monitoring and osteoporosis prevention, while 9.3% pts with RA and 7.5% women with SSc needed anti-osteoporotic treatment.

Disclosure of Interests:

None declared

Quality of life for up to 18 months after low-energy hip, vertebral, and distal forearm fractures-results from the ICUROS

This study used data from the International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) to estimate the quality of life (QoL) impact of fracture. Hip, vertebral, and distal forearm fractures incur substantial QoL losses. Hip and vertebral fracture results in markedly impaired QoL for at least 18 months.

INTRODUCTION

The International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) is a multinational observational study that aims to describe costs and quality of life (QoL) consequences of osteoporotic fractures. To date, 11 countries have participated in the study: Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, the UK, and the USA. The objective of this paper is to describe the QoL impact of hip, vertebral, and distal forearm fracture.

METHODS

Data were collected at four time-points for five QoL point estimates: within 2 weeks after fracture (including pre-fracture recall) and at 4, 12, and 18 months after fracture. Quality of life was measured as health state utility values (HSUVs) derived from the EQ-5D-3L. Complete case analysis was conducted as the base case with available case and multiple imputation performed as sensitivity analyses. Multivariate analysis was performed to explore predictors of QoL impact of fracture.

RESULTS

Among 5456 patients enrolled using convenience sampling, 3021 patients were eligible for the base case analysis (1415 hip, 1047 distal forearm, and 559 vertebral fractures). The mean (SD) difference between HSUV before and after fracture for hip, vertebral, and distal forearm fracture was estimated at 0.89 (0.40), 0.67 (0.45), and 0.48 (0.34), respectively (p < 0.001 for all fracture types). Eighteen months after fracture, mean HSUVs were lower than before the fracture in patients with hip fracture (0.66 vs. 0.77 p < 0.001) and vertebral fracture (0.70 vs. 0.83 p < 0.001). Hospitalization and higher recalled pre-fracture QoL were associated with increased QoL impact for all fracture types.

CONCLUSIONS

Hip, vertebral, and distal forearm fractures incur substantial loss in QoL and for patients with hip or vertebral fracture, QoL is markedly impaired for at least 18 months.